CPC Case of the Month

SCIRRHOUS ADENOCARCINOMA OF BREAST

Submitted by: William Resh, MD and James Nickel, MD, San Diego, CA

CLINICAL The patient is an 85-year-old white female with a history of hardened immobile red skin over atrophic breast, present for less than 1 year. Clinical diagnosis: scleroderma vs. carcinoma.
HISTOLOGY Numerous small proliferating malignant appearing epithelial type cells, some of which have a prominent linear “indian file” arrangement in a dense fibrotic stroma. Cytologic features of malignancy include nuclear molding by adjacent cytoplasm. Immunohistochemical stains for estrogen receptors, progesterone receptors, epithelial membrane antigen, and low molecular weight cytokeratin are all positive.
IMPORTANT FEATURE: REASON FOR PRESENTATION Small cells with subtle malignant features in fibrotic stroma that could be mistaken for inflammation and scar; good immunohistochemical stains confirm the mammary origin of the tumor cells.
REFERENCES 1. Lookingbill DP, Spangler N, Sexton FM. Skin involvement as the presenting sign of internal carcinoma. A retrospective study of 7316 cancer patients. J Am Acad Dermatol 1990; 22:19-26. 2. Pakula AS, Robinson JK. Recognizing malignant skin changes following breast cancer. Am Fam Physician 1992;45:1287-1292.