Rare and aggressive breast cancer; Caused by tumor emboli within dermal lymphatics; Tumor is intrinsically angiogenic/angioinvasive

Epidemiology: Accounts for 0.5% - 2% of invasive breast cancers. Average age at diagnosis: 59. At diagnosis, nearly all patients have lymph node involvement and 1 in 3 have distant metastases; Prognosis is poor and risk of recurrence is high; Five-year disease-free survival: 20-45%

Clinical presentation: Rapid onset (< 6 mos) of symptoms of inflammation affecting > 1/3 of the breast: peau d’orange, erythema, edema/enlargement, warmth, pain/itching, nipple changes. Typically no palpable or mammographic mass. Most common incorect diagnosis: Mastitis (Fever, leukocytosis, improvement with antibiotics)

Diagnosis: Core biopsy or skin punch biopsy + axillary sampling; CT and bone scan to evaluate for distant metastases

Mammogram features (variable): Most specific finding is asymmetric skin thickening

Treatment: Chemotherapy, Mastectomy, Radiation therapy

1. Neoadjuvant chemotherapy +/- adjuvant endocrine therapy/HER2-directed therapy (based on immunohistopathology)

2. Modified radical mastectomy (not skin-sparing!) with breast reconstruction delayed until after radiation therapy

3. Post-mastectomy chest wall radiation therapy

(Taghian 2016)

MALIGNANT BREAST DISORDERS:

Inflammatory Breast Cancer