Carcinoma en cuirasse as an initial manifestation of inflammatory breast cancer

Carcinoma en cuirasse is an uncommon clinical manifestation of metastatic cutaneous carcinoma characterized by diffuse sclerodermoid induration of the skin. The name was given in the first description by Velpeau in 1838 based on its resemblance to the steel breastplate of cuirassier (cavalry soldier) [1]. Other terms for this distinctive morphological variant of cutaneous metastasis include armoured cancer, Panzerkrebs, scirrhous carcinoma and Acarcine eburnee [2, 3]. Usually Carcinoma en cuirasse occurs in patients with local tumour relapse after mastectomy, albeit in some subjects it develops as a presenting feature of primary breast cancer (BC) [4]. Rarely, this form of cutaneous metastasis was associated with other adenocarcinomas (e.g. carcinoma of the lung, kidney or gastrointestinal tract) [5].
A 73-year-old woman, without any relevant concomitant diseases, presented with a 15-month history of asymptomatic, previously untreated erythematous and indurated skin lesions of the right chest. The patient denied any other dermatological conditions, had no family and personal history of malignant neoplasms and did not report such symptoms like fever, night sweats or weight loss.
On admission, the patient was in good general condition, afebrile, with only slight fatigue present. Skin examination disclosed an extensive, prominently indurated shiny infiltration covering the entire range of the markedly retracted right mammary gland extending to the adjacent area of the chest, right arm and upper back (Figure 1). Exceptionally sharp demarcation was particularly striking as the above-described lesion reached the right clavicle with its superior margin spreading down to just reach the inframammary fold with its inferior border. The medial edge of the plaque was distinctly limited by a midsternal line, slightly crossing it and extending laterally to the left parasternal line at the level of the first two ribs. The lateral spread was more linear, extending progressively to the paravertebral line and involving a large part of the right scapular region. The primary infiltration was accompanied by satellite lesions with the most extensive one located in the right epigastric region and the other ones disseminated on the right arm. Notable reduction of the involved breast volume was noted. The nipple, from which no discharge was observed, was neither retracted nor depressed, but could not be invaginated. As a result of induration of the skin...


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