Rosen's Breast Pathology, 4e

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Chapter 33

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FIG. 33.36.  Inflammatory recurrent carcinoma. Dermal infiltration with recurrent carcinomas on the chest wall and the clinical manifestations of inflammatory carcinoma. Shown here are poorly dif- ferentiated ductal carcinoma (A) , papillary carcinoma (B) , mucinous carcinoma (C) , and ILC (D, detail in inset ) .

the clinical signs of inflammatory carcinoma when initially treated, parenchymal intralymphatic tumor emboli were seen in many of the mastectomy specimens. A number of these patients also had lymphatic tumor emboli in the nipple and/ or the skin of the breast (Fig. 33.37). The majority of patients with an inflammatory recurrence initially have metastases in­ volving many enlarged ALNs, but this type of recurrence can develop in a patient who did not have ALN metastases. The term “occult inflammatory carcinoma” describes a group of patients who have cutaneous and parenchymal lymphatic tumor emboli associated with their primary tu­ mor in the absence of cutaneous erythema and other clinical changes that typify IBC. 224,269 Occult inflammatory carci­ noma occurs in 1% to 2% of patients with invasive carci­ nomas that are not clinically inflammatory. 269 The primary tumors tend to be central, larger than 4 cm, and often multi­ centric. The pathologic findings are not appreciably different

from those in women with primary IBC, and these patients are predisposed to develop inflammatory recurrences. 234

Treatment and Prognosis Until the introduction of combined modality treatment, including intensive chemotherapy, fewer than 5% of pa­ tients with IBC survived 5 years. 234 In recent years, the man­ agement of this disease has evolved into a multimodality approach that combines chemotherapy, surgery, and radio­ therapy. 271 In general, the currently favored therapeutic ap­ proach is preoperative chemotherapy to render the tumor operable, followed by mastectomy and radiation. 272 Although one group of investigators suggested that IBC patients with no detectable dermal lymphatic tumor emboli had a more favorable prognosis, 223 others did not find this to be the case. 237,269,273 Patients with “occult” IBC may have a