title: Skin thickening as unique pathologic sign of an inflammatory breast cancer: a case report and review of the literature.
abstract: We report the case of a 42-year-old woman with inflammatory cancer of the right breast treated with neoadjuvant chemotherapy, surgery, additional chemotherapy, and consolidative radiotherapy (RT), that has metastatized to the chest wall and presented a resumption of disease on the contralateral breast. Magnetic Resonance (MR), performed after the second phase's fourth round of additional chemotherapy, showed a modest reduction of scar metastases on the right and a contralateral anomalous skin thickening with high signal intensity in T2 weighted images (WI) with multiple mass-like enhancements located in a wide area of the central region at the union of higher quadrants. These findings were suggestive for resumption of contralateral disease; the biopsy confirmed an inflammatory breast cancer (IBC) infiltrating lobular type with high mitotic rate. A retrospective evaluation of the previous MR exam, performed 5 months before, was conducted: on the left side only a modest skin thickening was found as an early sign. A careful review of the literature has confirmed that skin thickening, increased density and clinical signs of inflammation are the most common findings in inflammatory cancer. We report the case of a patient affected by IBC whose unique early sign of resumption on the contralateral breast was skin thickening.
authors.affiliation: Department of Radiology, Policlinico Umberto I, Sapienza University of Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ballesio
authors.forename: I
authors.initials: I
authors.lastname: D'Ambrosio
authors.forename: N
authors.initials: N
authors.lastname: Ravazzolo
authors.forename: M
authors.initials: M
authors.lastname: Angeletti
authors.forename: F
authors.initials: F
authors.lastname: Di Pastena
authors.forename: S
authors.initials: S
authors.lastname: Tardioli
authors.forename: P
authors.initials: P
authors.lastname: Lodise
authors.forename: M
authors.initials: M
authors.lastname: Marini
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018275:Carcinoma, Lobular / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002921:Cicatrix / Q000473:pathology*; D003131:Combined Modality Therapy; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D019042:Muscle Neoplasms / Q000188:drug therapy / Q000556:secondary; D020360:Neoadjuvant Therapy; D010369:Pectoralis Muscles / Q000473:pathology; D018714:Radiotherapy, Adjuvant; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*; D035441:Thoracic Wall