Clinical Images

Right Breast Erythema and Tenderness

Eralda Mema MD, Emma Cho, Nikita Consul BS, Bret Taback MD

May 15th, 2018

A 63-year-old Hispanic woman presented to the clinic for a one-month history of progressively enlarging right breast with redness and tenderness.  She had no personal or family history of breast cancer, was post-menopausal and had never been on hormonal therapy.

Physical examination revealed an enlarged, erythematous, indurated right breast.  The skin appeared thickened and edematous with a peau d’orange appearance, which gave the breast a pitted or ridged look, similar to that of an orange skin (See Image 1). Multiple fixed upper outer right breast masses and multiple enlarged right axillary nodes were palpated.  Left breast was normal on exam.

Mammogram mediolateral oblique view (MLO) and cranial-caudal (CC) views demonstrated focal asymmetries involving most of the upper, mid and lower outer right breast. It also showed diffuse skin thickening (demarcated by red arrow on Image 2), trabecular coarsening and increased overall density of the right breast with enlarged right axillary lymph nodes (demarcated by yellow arrow Image 2).  The left breast was unremarkable on mammogram, without evidence of masses.

MCQ 1. What are the criteria for diagnosing inflammatory breast cancer? (4)

1. Presence of rapid onset breast edema and/or peau d’orange, erythema,

with or without presence of an underlying palpable abnormality

2. Duration of symptoms typically less than 3 months

3. Invasive carcinoma on pathology

4. Erythema involving at least one third of the breast.

5. Punch biopsy result showing dermal lymphatic involvement

6. All of the above

7. ABCD only 

8. ABC only

Click here for answer

References:

1. Hance KW, Anderson WF, Devesa SS, Young HA, Levine PH. Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst 2005;97(13): 966–975. CrossRef, Medline

2. Yeh ED, Jacene HA, Bellon JR, et al. What Radiologists Need to Know about Diagnosis and Treatment of Inflammatory Breast Cancer: A Multidisciplinary Approach. Radiographics 2013; 33: 2003-2017.

3. Dawood S, Merajver SD, Viens P, et al. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol 2011;22(3):515–523.

4. Edge SF, Byrd DR, Compton CC, et al. AJCC cancer staging manual, 7th ed, Springer, New York 2010.

Author Information:

1. Eralda Mema, MD, is a Radiology Resident (PGY IV) in the Department of Radiology at Columbia University Medical Center.
   
2. Emma Cho is a Research Intern in the Department of Radiology at Columbia University Medical Center.
   
3. Nikita Consul is a Medical Student (MS IV) at Columbia University College of Physicians and Surgeons.
   
4. Bret Taback, MD, is a Surgical Oncologist in the Department of Surgery at Columbia University Medical Center.