Contents

Search

inflammatory breast cancer; mastitis carcinomatosa

Epidemiology: - incidence of inflammatory breast cancer increases with age, peaking at ~65 years then stabilizes or decreases slightly - most cases are diagnosed in women 40-59 years of age - case of 33 year old woman [1] - 3% of all breast cancers Pathology: - aggressive, rapidly progressive cancer - lymphatic obstruction due to invasive breast adenocarcinoma - edema, inflammation - dermal-lymphatic infiltration - despite name, not associated with inflammatory infiltrate [3] Clinical manifestations: - erythema, edema & thickening of the breast skin (may have the appearance of an orange peel, peau d'orange) - pruritus, pain, tenderness, warmth - involves at least one-third of the breast - no fever - nipple retraction can occur - in most cases a distinct breast mass not felt Laboratory: - complete blood count (CBC): no leukocytosis Special laboratory: - breast biopsy of inflammed tissue - presence of lymphatic emboli in a breast biopsy Diagnostic criteria: - based upon clinical appearance [1] Radiology: - not diagnostic, part of staging for breast cancer - CT of abdomen & thorax - bone scan [1] Differential diagnosis: - can mimic acute mastitis - mastitis commonly occurs in lactating women Complications: - high risk for metastases [1] - axillary vein thrombosis [1] Management: - neoadjuvant chemotherapy or endocrine therapy, mastectomy & adjuvant radiation therapy [1]

General

breast cancer mastitis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. Chia S, Swain SM, Byrd DR, Mankoff DA. Locally advanced and inflammatory breast cancer. J Clin Oncol. 2008 Feb 10;26(5):786-90 PMID: 18258987
  3. WHO Classification of Tumors of the Breast and Female Genital Organs. Editors: Tavassoli FA, Devilee P IARC Press, 2003
  4. NEJM Knowledge+ Question of the Week. Sept 11, 2018 https://knowledgeplus.nejm.org/question-of-week/945/
  5. Dushkin H, Cristofanilli M. Inflammatory breast cancer. J Natl Compr Canc Netw 2011 Feb 12; 9:233 PMID: 21310844
  6. Jagsi R, Mason G, Overmoyer BA, et al; Susan G. Komen-IBCRF IBC Collaborative in partnership with the Milburn Foundation. Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research. Breast Cancer Res Treat. 2022;192:235-43. PMID: 34973083
  7. Hester RH, Hortobagyi GN, Lim B. Inflammatory breast cancer: early recognition and diagnosis is critical. Am J Obstet Gynecol. 2021 Oct;225(4):392-396. PMID: 33845027 Review.