Pictorial case study: Inflammatory breast cancer

The case
A 72-year-old woman presented concerned about discomfort in her left breast. She was otherwise well and on medication only for hypertension. She had no past history of breast problems. On examination, her left breast appeared red and swollen. The skin overlying this part of the breast had a pitted appearance. The breast was tender to touch and there was a possibility of a lump. No lymph nodes were palpable in the axillae or supraclavicular fossa.

What is the diagnosis, management and differential diagnoses?

Diagnosis and management
This is a case of inflammatory breast cancer, and symptoms often develop suddenly. There may be ridges and raised marks on the skin of the breast giving a pitted appearance, resembling the skin of an orange and giving rise to the name peau d’orange. If peau d’orange is found overlying a definite lump in the breast, it is almost pathognomonic of carcinoma. Peau d’orange indicates a serious and aggressive tumour that grows more quickly than other breast cancers and which is automatically classified stage IIIB.

This woman was referred to the breast clinic, where breast cancer was confirmed with mammography and biopsy.

Possible different diagnoses

  • Mastitis.
  • Breast abscess.

Differential diagnosis
Mastitis

  • Usually related to breastfeeding
  • Breast is swollen, inflamed, tense and tender.
  • There is no risk to the baby by continuing to breastfeed if mastitis occurs.
  • Treatment is by emptying of the breast by breastfeeding.
  • Cooling ice packs may help and oral antibiotics may be required.

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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