Carcinoma en-cuirasse a rare cutaneous presentation of breast malignancy

¹Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

^&Corresponding author
Harshith Gowda, Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

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A 65-year-old female complained of a lump in the right breast for 6 months, gradually increasing from the size of pea to the size of a lemon. The lesion was involving and causing retraction of the nipple areola complex, with ulceration and hemorrhagic discharge. On contrast computed tomography (CT) of the thorax, there was an ill-defined heterogeneously enhancing mass lesion with central hypodense area and speculated margins in the retro-areolar region, measuring approximately 7 x 3.2 x 1.9 cm. The lesion was causing architectural distortion of nipple areolar complex with cutaneous and subcutaneous extensive thickening and fat stranding. Computed tomography of the abdomen also revealed multiple liver metastasis. Biopsy from right breast lump revealed invasive ductal carcinoma. Patient was advised palliative chemotherapy. Carcinoma en-cuirasse is a rare presentation of either scirrhous breast carcinoma or cutaneous metastasis which usually spreads through lymphatics. It is highly invasive slow growing variant showing extensive fibrous and dense connective tissue encasing the chest wall. Stromal reaction has been interpreted as either promoting tumor angiogenesis and physical fibrillar matrix components or creating a barrier to halt tumor spread. The dense stromal matrix and less vascularity may be the reason why the tumor is relatively resistant to systemic chemotherapy.

Figure 1: A) large nodular breast mass involving nipple areolar complex. It is associated with serosanguinous and hemorrhagic discharging ulcers; B) contrast CT thorax - an ill-defined heterogeneously enhancing mass lesion with central hypodense area and speculated margins in the retro-areolar region with cutaneous and subcutaneous extensive thickening and fat stranding