Case Report: Carcinoma en Cuirasse in a Middle-Aged Woman Mimicking Postirradiation Morphea

Abstract

Breast carcinoma en cuirasse (CeC) is an extremely rare form of cutaneous metastases of breast cancer, characterized by diffuse sclerodermoid induration of the skin. It may be difficult to distinguish CeC from some skin diseases, including postirradiation morphea, inflammatory breast cancer, radiation dermatitis, and other cutaneous metastases, but it can be easily discerned by histology. Because of the small number of documented cases, the treatment consensus has not been clearly defined. Here, we show a 45-year-old woman with grade III infiltrating ductal carcinoma manifesting as CeC to the chest wall. Early diagnosis and treatment are essential to prevent the catastrophic natural progression of this rare malignancy.

Cutaneous lymphangitis carcinomatosa: a unique presentation of a rare disease

“…Additionally, lymphedema is usually present due to lymphatic involvement [5]. Notably, whenever cutaneous lymphangitic carcinomatosa is suspected, other conditions with similar underlying histology but different nuances in clinical morphology such as carcinoma erysipeloides, carcinoma telangiectoides, carcinoma hemorrhagiectoides, and carcinoma en cuirasse [12][13][14][15][16][17][18]. A comparison of the clinical morphology and histology of these conditions is listed in Table 1; as may be noted, a wide variety of terms exist to describe the underlying pathologic finding of malignant cell invasion [10].…”

“…Almost exclusively seen in breast cancer [13] Erythematous patch with prominent telangiectasias [13,14] Red papules/papulovesicles [13,15] Tumor cells infiltrating blood vessels with minimal invasion of dermis [14] Tumor cells in superficial lymphatics and blood vessels only [15] Carcinoma hemorrhagiectoides Indurated, violaceous, purpuric plaque, classically in a distribution of a medieval knight's shield (positive "shield sign"), [14] Tumor cells infiltrating blood vessels and/or lymphatic vessels, with diffuse invasion of dermis as well [14] Carcinoma en cuirasse Almost exclusively seen in breast cancer [13,16] Scattered, flesh-colored nodules on an erythematous background that progress to a coalesced, diffuse sclerodermoid plaque [16,17] Peau d'orange appearance resembling morphea, radiation dermatitis, Paget's disease of the breast, or infection [13,16] Spread is slower and more discontinuous than that of carcinoma erysipeloides [18] Dense infiltration of the dermis by tumor cells in single file lines or small clusters [13,17] Distinguished from postirradiation morphea by presence of tumor cells [17]…”