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  Table of Contents  
LETTER TO THE EDITOR
Year : 2014  |  Volume : 5  |  Issue : 3  |  Page : 348-349  

Purpuric plaque on the neck of a patient with breast carcinoma


1 Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
2 Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Date of Web Publication31-Jul-2014

Correspondence Address:
Lily Adelzadeh
4255 La Salle Ave, Culver City CA
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.137802

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How to cite this article:
Adelzadeh L, Breithaupt A, Jackson J, Worswick S. Purpuric plaque on the neck of a patient with breast carcinoma. Indian Dermatol Online J 2014;5:348-9

How to cite this URL:
Adelzadeh L, Breithaupt A, Jackson J, Worswick S. Purpuric plaque on the neck of a patient with breast carcinoma. Indian Dermatol Online J [serial online] 2014 [cited 2020 Apr 3];5:348-9. Available from: http://www.idoj.in/text.asp?2014/5/3/348/137802

Sir,

A 78-year-old woman presented with a purpuric plaque over the left lateral aspect of her neck upon admission for urosepsis due to Klebsiella. The patient was nonverbal and the only caretaker to offer her history was unable to provide any relevant information on the lesion. Her medical history was notable for lobular carcinoma of the breast with multiple osseous metastases postlumpectomy, chemotherapy, and multiple radiation therapy. She was afebrile, normotensive, and had a normal pulse on initial examination. Physical examination was notable for a 10 cm purpuric minimally indurated plaque over the left lateral aspect of her neck and jawline [Figure 1].
Figure 1: A 10 cm purpuric minimally indurated plaque over the left lateral neck and jawline

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Histopathologic examination demonstrated a poorly differentiated infiltrating adenocarcinoma, with extensive lymphatic and vascular invasion [Figure 2] and [Figure 3]. Immunohistochemistry showed strong positive staining of tumor nuclei with antibodies to estrogen receptor protein, progesterone receptor protein, cytokeratin 7, and mammaglobin, with negative staining of tumor cells with antibodies to Her2/neu protein. Given the histopathology and the clinical presentation of the lesion, a diagnosis of telangiectatic metastatic breast carcinoma (TMBC) was made.
Figure 2: H and E, ×40 reveals poorly differentiated adenocarcinoma, with extensive lymphatic and vascular invasion

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Figure 3: H and E, ×4 reveals poorly differentiated adenocarcinoma, with extensive lymphatic and vascular invasion

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Breast carcinoma, the second most common cancer among women after nonmelanoma skin cancer, has an incidence of skin metastases of 23.9%. [1] In a retrospective review by Mordenti et al., cases of skin metastases specifically from breast carcinoma were examined to determine the most common clinical and histopathologic presentations. Skin papules and/or nodules were found in 80% of patients, TMBC in 11%, erysipeloid carcinomas in 3%, "en cuirasse" carcinomas in 3%, alopecia neoplastica in 2%, and a zosteriform type in 0.8%. [2],[3],[4],[5],[6],[7],[8] TMBC clinically can present as a patch of telangiectasias, a purpuric plaque, or as lymphangioma circumscriptum-like pseudovesicles. [9]

Differentiating TMBC from other cutaneous lesions can be challenging based on clinical features alone, due to the ability of the tumor to mimic arteriovenous malformation, angiotropic lymphoma, hemangioma, Kaposi's sarcoma, angiosarcoma, and benign atypical vascular proliferations. [10] Histopathology of TMBC shows aggregates of atypical lobular cells and erythrocytes with dilated lymphatic channels in the papillary dermis; sometimes intravascular calcifications can be seen. A study analyzing the pathology of various cutaneous metastatic breast carcinomas showed that intralymphatic tumor-cell emboli were common in those with TMBC. [11]

 
   References Top

1.De Giorgi V, Grazzini M, Alfaioli B, Savarese I, Corciova SA, Guerriero G, et al. Cutaneous manifestations of breast carcinoma. Dermatol Ther 2010;23:581-9.  Back to cited text no. 1
    
2.Mordenti C, Peris K, Concetta Fargnoli M, Cerroni L, Chimenti S. Acta dermatovenerologica. Cutaneous metastatic breast carcinoma; 2000 p. 9. Available from: http://www.mfuni-ljsi/acta-apa/acta-apa-00-4/mordenti.html [Last accessed date 2008 Jul 21].  Back to cited text no. 2
    
3.Chandanwale SS, Gore CR, Buch AC, Misal SS. Zosteriform cutaneous metastasis: A primary manifestation of carcinoma breast, rare case report. Indian J Pathol Microbiol 2011;54:863-4.  Back to cited text no. 3
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4.Mahore SD, Bothale KA, Patrikar AD, Joshi AM. Carcinoma en cuirasse: A rare presentation of breast cancer. Indian J Pathol Microbiol 2010;53:351-8.  Back to cited text no. 4
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5.Prabhu S, Pai SB, Handattu S, Kudur MH, Vasanth V. Cutaneous metastases from carcinoma breast: The common and the rare. Indian J Dermatol Venereol Leprol 2009;75:499-502.  Back to cited text no. 5
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6.Rao R, Balachandran C, Rao L. Zosteriform cutaneous metastases: A case report and brief review of literature. Indian J Dermatol Venereol Leprol 2010;76:447.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Vijaya B; Sunila, Veeranna S, Manjunath GV. Erythematous nodules of the hand: A rare site of metastatic breast carcinoma. Indian J Dermatol Venereol Leprol 2011;77:695-8.  Back to cited text no. 7
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8.Virmani NC, Sharma YK, Panicker NK, Dash KN, Patvekar MA, Deo KS. Zosteriform skin metastases: Clue to an undiagnosed breast cancer. Indian J Dermatol 2011;56:726-7.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.Lin JH, Lee JY, Chao SC, Tsao CJ. Telangiectatic metastatic breast carcinoma preceded by en cuirasse metastatic breast carcinoma. Br J Dermatol 2004;151:523-4.  Back to cited text no. 9
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10.Dobson CM, Tagore V, Myint AS, Memon A. Telangiectatic metastatic breast carcinoma in face and scalp mimicking cutaneous angiosarcoma. J Am Acad Dermatol 2003;48:635-6.  Back to cited text no. 10
    
11.Yun SJ, Park HY, Lee JS, Park MH, Lee JB, Won YH. Clinicopathological correlation of cutaneous metastatic breast carcinoma using lymphatic and vascular markers: Lymphatics are mainly involved in cutaneous metastasis. Clin Exp Dermatol 2012;37:744-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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