PMC3540655_01
(a) The right breast is raised higher than the left breast and demonstrates nipple inversion. (b) Indurated erythema spreads across the right upper breast and upper arm. (c) Indurated erythema across the right upper back. (d) Extensive lymphatic invasion by infiltrative cords of epithelial cells.
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fig1
On examination, the right breast was raised higher than the left, the right nipple was inverted, and indurated erythema extended from the upper R breast to the upper arm and back (Figures 1(a), 1(b), and 1(c)). Skin biopsies of the indurated red areas on the chest and arm showed extensive infiltrative cords of epithelioid cells with ductal differentiation and lymphatic invasion, consistent with infiltrative breast carcinoma (Figure 1(d)).
PMC3540655_02
(a) Indurated left mastectomy scar with diffuse erythema and purpura. (b) The skin changes extend into the left axilla and back. (c) Groups of cells with pleomorphic nuclei and pale eosinophilic cytoplasm infiltrating dermal collagen. (d) Dermal infiltration by carcinoma.
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fig2
On examination, there was diffuse erythema and areas of purpura on the left chest wall extending to the left back, with induration over the mastectomy scar (Figures 2(a) and 2(b)). Further skin biopsies revealed infiltrating adenocarcinoma in the dermis (Figures 2(c) and 2(d)).
PMC3540655_03
(a) The right breast displays patchy erythema with purpuric borders. (b) High-grade invasive ductal carcinoma infiltrating dermis, with mitotic figures.
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fig3
Four skin biopsies showed widespread infiltration of the dermis by metastatic adenocarcinoma (Figures 3(a) and 3(b)).
PMC3540655_04
Focus of dermal lymphatic invasion with a mitotic figure.
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fig4
Biopsies from both regions showed infiltration of dermal lymphatics by metastatic ductal carcinoma, which was hormone receptor negative (Figure 4).