Diagnosis

Inflammatory breast cancer

Findings

CC and MLO images (Figure 1) of the right breast demonstrate a round mass in the inferolateral quadrant of the right breast underlying a palpable marker.  Subtle trabecular and skin thickening are also evident on the mammographic images, and an abnormal lymph node is partially imaged in the right axilla.  Spot compression views of the inferolateral right breast (Figure 2) reveal the palpable mass to be an irregular, high density mass with indistinct margins.  A staging CT scan (Figure 3) performed after biopsy of the breast mass more clearly demonstrates significant skin thickening in the right breast as well as an abnormal right axillary lymph node.

Discussion

Breast edema may present in a unilateral or bilateral fashion.  Bilateral breast edema occurs in the setting of underlying systemic disease such as anasarca, liver disease, renal failure or heart failure.  Unilateral breast edema is a more worrisome finding since it may be associated with breast carcinoma.

Inflammatory breast carcinoma is an invasive carcinoma which involves the dermal lymphatics of the breast.  This dermal lymphatic involvement results in diffuse thickening and redness of the skin of the involved breast, causing the classic peau d’orange appearance seen clinically.  Inflammatory carcinoma is a rare form of breast cancer and is associated with a poor prognosis compared with other presentations of breast cancer.  For this reason, it is important to distinguish locally advanced breast cancer which may involve the skin from inflammatory breast cancer. Other causes of unilateral breast edema that can potentially mimic inflammatory breast cancer include mastitis, trauma and prior radiation therapy.

Conclusion

Early and accurate distinction of these benign causes of unilateral breast edema from inflammatory breast carcinoma is important and should be possible based on the clinical history.

1. Ikeda DM. Breast Imaging: The Requisites.  Philadelphia, PA: Elsevier; 2004.