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Findings: Sequential MLO views are offered.
3-23-95 Right MLO-normal.
8-21-95 Right MLO-increased glandular component, diffuse increase in breast density, skin thickening, and nipple retraction.

Diagnosis:Inflammatory carcinoma.

Discussion: A biopsy of this woman's right breast following the 8-21-95 mammogram revealed invasive ductal carcinoma, inflammatory type. Dermal lymphatic invasion was prominent.

The clinical manifestation of Inflammatory Carcinoma are increased warmth, erythema, and peau d'orange skin thickening. These symptoms are similar to mastitis, a benign inflammatory process. However, mastitis will be cured by antibiotic therapy, while Inflammatory Carcinoma will not.

Histologically, Inflammatory Carcinoma is characterized by diffuse early dermal lymphatic invasion from an aggressive form of infiltrating ductal carcinoma. The prognosis is ominous for these patients; worse than for carcinoma that has secondarily invaded the skin. Almost 90% of patients have metastatic disease at the time of diagnosis.

Mammographically, the skin appears thickened in a non-specific fashion. Diffuse trabecular thickening may increase radiographic density of the breast. Occasionally, a tumor mass with or without microcalcifications is seen. The differential diagnosis includes cellulitis, mastitis, locally advanced non-inflammatory carcinoma, radiation changes and edema (anasarca).

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