CLINICAL A 77-year-old female had a modified right radical mastectomy in August 1998 for infiltrating ductal carcinoma of the breast. Eight of 17 axillary nodes were positive. She received eight cycles of CMF adjuvant therapy over a 5-month period. Chest wall nodules appeared within 2 months after completion of chemotherapy. Ultimately she developed a confluence of erythematous nodular indurated lesions extending from the mid chest to the axilla and shoulder, covering a gross area of approximately 30 x 12 cm. These nodules initially responded to radiation, but she developed lymphedema and decreased mobility of her arm. Many antineoplastics provided no benefit. Skin changes became more pronounced over the period May-October 2001, involving the arm, shoulder, and chest. This biopsy was taken in Sept. 2001 and the clinical photos in October 2001. The patient expired in Feb. 2002.
HISTOLOGY Metastatic carcinoma in the dermis consistent with breast origin. Her-2/neu, ERA, and PRA were negative. Ki-67 labeling was 50%, an unfavorable finding.
IMPORTANT FEATURE: REASON FOR PRESENTATION An unusual manifestation of metastatic carcinoma with good clinical photographs.

REFERENCES

1. Kumar PP, Good RR, Jones EO, Edney JJ, Johansson S L. Breast carcinoma encuirasse: Pathophysiology and rotational subtotal skin electron beam therapy (SSEBT)
,A new technique. Radiat Med 1989(Mar-Apr); 7(2);95-104.

2. Neumann-Redlin E, Horstschafer W. [A rare case of cancer en cuirasse in an untreated breast carcinoma of 24 years’ duration.] Zentralbl Bakteriol [Orig B] 1975; 91(9):568-572.