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Short Communication - Breast carcinoma presenting as carcinoma en cuirasse.

Sir, carcinoma en cuirasse is a form of cutaneous metastasis. Although this condition is rare, it is most commonly associated with breast carcinoma with local recurrence after mastectomy. It presents most commonly a few months or years after the surgical operation or rarely, the condition presents as the presenting manifestation of the disease. It is of diagnostic importance because it may be the first manifestation of hitherto undiscovered internal malignancy or the first indication of an inadequately treated malignancy.

Table 1 Cutaneous manifestations of breast carcinoma described in the literature.

Clinical morphology###N (%)

Nodular carcinoma###141 (46.8)

Alopecia neoplastica###36 (12)

Telangiectatic carcinoma###25 (8)

Malignant melanoma-like metastasis###19 (6.3)

Carcinoma ersipelatoides###19 (6.3)

Subungual metastasis###14 (4.6)

Carcinoma en curasse###13 (4)

Zosteriform metastases###11 (3.6)

Metastasis to eyelids###7 (2.3)

Paget-like metastases###4 (1.3)

Dermatomyositis###3 (0.9)

Granuloma pyogenic-like metastases###2 (0.6)

Multicentric reticulohistiocytosis###1 (0.3)

Sister Mary Joseph's nodule###1 (0.3)

Metastatic squamous cell carcinoma###1 (0.3)

Occult metastasis###1 (0.3)

Infection-like acral cutaneous###1 (0.3)

metastasis

Clown nose###1 (0.3)

Targetoid cutaneous metastases###1 (0.3)

Nodule on benign intradermal nevus###1 (0.3)

Erythema annulare centrifugum-like###1 (0.3)

Dermatitis-like metastases###1 (0.3)

Calciphylaxis###1 (0.3)

We report a case of a 35-year-old female patient who presented with indurated skin lesions over the breast, the axilla and the chest wall. She presented with 6 months history ofmultiple skin lesions over the left breast, left shoulder and the left side of the upper back, extending to involve the retroauricular region and the neck. She also had swelling of the left upper limb for duration of one month. The lesions initially started as asymptomatic papules and plaques on the neck and retroauricular areas which increased in number and size to involve chest and back of the same side. She also gave history of difficulty in having full range of motion of the left shoulder joint. There was no history of anorexia or weight loss. She denied any dermatological diseases and her personal history was unremarkable.

On examination, multiple indurated nodules and plaques were present over the left breast, the left retroauricular area, the scapular region and the neck (Figure 1, 2). Multiple grouped vesicles on an erythematous base were seen over the left breast and the neck. Breast examination revealed a hard non-tender mobile swelling of 3-4 cm over the left breast. Posterior axillary lymph nodes were significantly enlarged and there was diffuse swelling of the left upper limb. On the basis of cutaneous and breast examination findings, a provisional diagnosis of carcinoma en cuirasse was made and diagnosis was confirmed with skin biopsy which showed groups of malignant cells suggestive of cutaneous deposits of ductal carcinoma (Figure 3).

Cutaneous metastasis is a phenomenon that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The primary malignant tumor that most commonly metastasizes to the skin in women is breast cancer, which can be manifested through wide range of clinical features (Table 1).1,2

The incidence of cutaneous metastasis varies from. 6% to 10%. Carcinoma en cuirasse is a form of metastatic cutaneous carcinoma. It is usually seen in patients with carcinoma breast who have undergone mastectomy, but rarely this can be the primary presentation of carcinoma breast (similar to our case).3

It was first described by Velpeau in 1838, a description chosen because of its resemblance to the metal breastplate of a cuirassier. It has also been called scirrhous carcinoma, pachydermia and Acarcine eburnee by various authors.4

In our case the patient only had skin lesions and was unaware of underlying malignancy. She sought the medical help only after lesions progressed to entire half of the trunk and caused restriction of shoulder movement. Cutaneous matastasis always indicates a grave prognosis and early diagnosis can make a big difference in the management and subsequently in prognosis. Carcinoma en cuirasse may be the first clinical manifestation of internal malignancy especially carcinoma breast. So it is the responsibility of the dermatologist to have high index of suspicion in patients presenting with cutaneous features suggestive of metastasis and manage accordingly.

References

1. De giorgi V, Grazzini M, Alfaioli B, Savarese I, Corciova SA, Guerriero G, Lotti T. Cutaneous manifeatations of breast carcinoma. Dermatol Ther. 2010;23:581-9.

2. Oliveira GM, Zachetti DB, Barros HR, Tiengo A, Romiti N. Breast carcinoma en cuirasse - case report. An Bras Dermatol. 2013;88:608-10.

3. Mahore SD, Bothale KA, Patrikar AD, Joshi AM. Carcinoma en cuirasse: A rare presentation of breast cancer. Indian J Pathol Microbiol. 2010;53:351-8.

4. Carlesimo M, Rossi G, Narcisi A, Cacchi C, Mari E, Persechino F et al. Carcinoma en cuirasse of the breast. Eur J Dermatol. 2009;19:289-90.
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Publication:Journal of Pakistan Association of Dermatologists
Article Type:Report
Geographic Code:9PAKI
Date:Sep 30, 2016
Words:913
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