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Secondary T‐cell non‐Hodgkin's lymphoma of the breasts is a very rare disease and can be easily missed as inflammatory carcinoma at initial presentation. High index of suspicion and radiological investigations has a big role in identifying the primary lymphoma.

Mastitis is an infectious or noninfectious inflammation of the mammary glands. The most important differential diagnosis of mastitis is an inflammatory carcinoma, which can be excluded by imaging and a biopsy. Noninfectious mastitis can also occur during pregnancy and knowledge of the possible differential diagnoses is essential for appropriate diagnostics and treatment.

Metastasis to the breast from all other primary sites is unusual. Twelve patients were diagnosed between 2007 and 2017 at National Cancer Institute, Mexico. Solitary or multiple masses, round or oval, and hypoechoic and solid lesions with posterior acoustic shadowing were patterns commonly reported in these patients; other arrangements include diffuse involvement of the breast simulating an inflammatory carcinoma. The development of a breast metastasis is revealed, in our experience, as a negative prognostic factor. Thus, the radiologist should know about the varied appearance of metastatic breast lesions and provide radiopathological correlations when available.

Reported cases encountered difficulty in differentiating between inflammatory carcinoma and breast edema caused by congestive heart failure especially if the breast edema is unilateral. Our presented case is an elderly woman with unilateral breast edema due to congestive heart failure that was initially suspected to have breast cancer based on clinical findings. However imaging studies showed breast edema pattern with no definite underlying mass. This edema was resolved with standard treatment of heart failure. Congestive heart failure may be a possible cause of unilateral breast edema especially in a patient with background of congestive heart failure. Keywords: Breast cancer, Inflammatorybreast cancer, Case report, Unilateral breast edema, Congestive heart failure

O carcinoma inflamatório mamário é um carcinoma anaplásico com características clínicas e histopatológicas como crescimento rápido, envolvimento difuso, eritema, calor e dor nas mamas, edema nos membros posteriores, extensa infiltração de células inflamatórias, células epiteliais malignas nos linfonodos regionais apresentando um péssimo prognóstico. O cão é a única espécie animal em que esta neoplasia ocorre espontaneamente, entretanto apresenta uma incidência bastante rara tanto em humanos quanto em caninos. Este trabalho descreve dois casos de carcinoma inflamatório mamário em duas cadelas da raça Dobermann apresentando aumento de volume mamário com espessamento da pele na região das mamas, com secreção liquido-sanguinolenta local, aumento da temperatura e dor no local e edema de membros posteriores. Em ambos os casos, o resultado do exame citológico revelou carcinoma anaplásico e os animais apresentaram uma rápida evolução da doença em menos de 30 dias, optando-se pela eutanásia nos dois casos. Os achados de necrópsia indicaram metástases pulmonares em ambos os cães e com o exame histológico confirmaram o diagnóstico de carcinoma anaplásico. Este trabalho elucida bem os sinais clínicos característicos dos cães com carcinoma inflamatório, que se assemelham muito a mastite, demonstra o prognóstico reservado desta enfermidade, além de chamar a atenção para este raro tumor ter ocorrido na mesma raça. The mammary inflammatory carcinoma is an anaplasic carcinoma with clinical and histopathological characteristics as rapid growth, diffuse involvement, eritema, warmth and pain of the mammary gland, edema in the posterior limbs, extense infiltration of inflammatory cells, malignant epithelial cells in the lymph nodes, presenting bad prognostic. The dog is the only animal specie that this tumor occurs naturally, however this tumor is rare in human and in dogs. The mammary inflammatory carcinoma is one of the most malignant tumors in dogs. This study describes two cases of mammary inflammatory carcinoma in two dobermans presenting an increase mass of the mammary tissue, thickening of the skin in the region of the breasts, serosanguineous discharge of the region, high local temperature and local pain and edema of posterior limbs. In both cases, was diagnosed anaplasic carcinoma by the histopathology and the animals presented a rapid evolution of the illness in less than 30 days, opting to euthanasia in both animals. The autopsy findings had disclosed pulmonary metastasis in both dogs and confirmed the result of anaplasic carcinoma of the cytology. These cases elucidate the characteristic clinical signals of the animals with inflammatory carcinoma, that is very similar as mastitis, demonstrates the bad prognostic of this disease, observing that this rare tumor occurred in two dogs of the same breed.

Introduction: Multidrug resistance (MDR) to anti-cancer drugs is a major issue for the treatment of breast cancer. Overexpression of the transmembrane protein P-glycoprotein (PGP) is involved in the MDR mechanism. PGP acts as an ATP-dependent drug transporter and pumps a wide spectrum of drugs out of the cell. Inflammatory breast cancer is a special type of breast cancer with the worst prognosis and a high mortality due to the lack of effective treatments. Therefore, many investigations are conducted to find effective therapies. The aim of the present study was to determine the immunolabelling of PGP in human and canine inflammatory mammary cancer cell lines and in the corresponding xenograft tumours in mice. Materials and Methods: Immunohistochemistry against PGP was performed in human and canine inflammatory mammary cancer cell lines (SUM-149 and IPC-366, respectively) growing in adherent and non-adherent (mammospheres) conditions and in the corresponding mouse xenografts. Results: Adherent cells of both cell lines showed the characteristic membranous expression of PGP, with!5% having cytoplasmic immunolabelling. A cytoplasmic and membranous clumped immunolabelling was found in the mammospheres of the cell lines. In contrast, tumours of the corresponding xenotransplanted mice did not express PGP in most of the cells:!5%of cells expressed a slight clumped membranous labelling. Conclusions: The lack of PGP immunolabelling found in the mouse xenografts suggests a loss of MDR related to PGP expression in the murine model. Although further studies are necessary, caution should be considered in experimental therapeutic studies carried out in xenografted mice.

Highlights • Infarction of breast fibroadenoma is a very rare complication. • Spontaneous infarction occurs mostly during pregnancy or lactation. • It poses a diagnostic dilemma of inflammatory diseases and inflammatory carcinoma due to their similarities both in clinical and cytological features., Introduction Infarction of breast fibroadenoma is a very rare complication which is either spontaneous or secondary to trauma. It poses a diagnostic dilemma of inflammatory carcinoma. We report a case of spontaneous infarction of fibroadenoma with different clinical presentation. Case report A 26-year-old female presented with right breast lump with sudden increase in size for 2 week duration. On examination, well defined, irregular lump measuring 6 × 3 cm and firm to hard in consistency was found. The clinical diagnosis of benin fibroadenoma of the breast was made. Ultrasound confirmed the diagnosis. biopsy was planned. Macroscopical and microscopical examination showed pictures consistent with spontaneous infarction of benign fibroadenoma of breast. Discussion Fibroadenomas are the most common benign tumor of breast among female gender. Spontaneous infarction within fibroadenoma is a very rare. To our knowledge, only 33 cases have been reported in literatures. Conclusion Spontaneous infarction of the fibroadenoma is a benign condition of the breast with features either inflammatory carcinoma or the same presentation of benign fibroadenoma.

Breast is an uncommon site to be affected in filariasis. However, such cases may be encountered in endemic areas. Here, we report a case of filariasis of breast in a 55-year-old woman who was clinically mistaken for inflammatory carcinoma of the breast. Sonomammography revealed classic signs pointing towards the diagnosis of filariasis of breast, which was confirmed with microscopic examination of fine-needle aspirate. Thus, imaging played a pivotal role in correctly diagnosing and further altering the line of management.

Non-mammary metastases involving breast are rare and most commonly involve the breast parenchyma. Infrequently, metastasis from an extramammary primary site presents as inflammatory carcinoma over the breast. Diagnosis of such lesions can be challenging, especially in patients with coexisting primary breast carcinoma. Few such cases have been described in literature; however, none of the previously reported cases had a prior history of primary breast carcinoma. We present 2 patients with history of breast carcinoma and serous carcinoma of ovarian/peritoneal origin that presented with inflammatory carcinoma over the breast. Biopsies from breast tissue showed atypical cells in the dermis forming cords and papillary structures. Histopathologic differential diagnosis included infiltrating ductal carcinoma of breast origin and metastatic serous carcinoma. Immunohistochemical studies showed that the tumor cells were positive for markers of ovarian origin such as PAX-8 and CA-125 and negative for breast markers such as GATA-3, thus supporting the diagnosis. In summary, we describe the unusual presentation of metastatic serous carcinoma as inflammatory carcinoma over breast and discuss the diagnostic challenges in patients with coexisting primary breast and ovarian malignancies. We also review the morphologic features of tumors of breast and ovarian origin and the immunohistochemical stains to differentiate these 2 entities.

Primary actinomycosis of the breast is a rare disease, with fewer than twenty cases reported since its description by Ammentorp in 1893. Breast actinomycosis is primary when inoculation occurs through the nipple. In this patient in our study, mammography suggested a diagnosis of inflammatory carcinoma that pathological examinations later confirmed as actinomycosis. In addition this study represents the first report of primary breast actinomycosis in post menopausal woman in India and 4 th in world.

The clinicopathological and immunohistochemical findings of a primary feline mammary tumour with features similar to human and canine primary inflammatory carcinoma are described for the first time. The cat presented to the clinic for the rapid onset of oedema, severe erythema, local pain and warmth of the inguinal region, with a pustular-to-nodular cutaneous lesion in association with an ill-defined underlying mass. An epithelial malignant tumour was diagnosed by cytological investigation. Necropsy revealed a thickening of the skin with oedema of the subcutis in the right inguinal area, and regional and distant metastases. Histology showed an unencapsulated tubulopapillary proliferation of malignant epithelial cells, with a massive embolisation in the dermal lymphatics and a mild inflammatory infiltrate. Through immunohistochemistry, the tumour was found to be oestrogen (ER)-alpha-, androgen (AR)- and progesterone (PR)-negative; neoplastic cells were ER-alpha, AR-negative and focally PR-positive. An irregular, mild and focal HER-2 immunoreactivity was present (score +1, non-HER-2 overexpressing). The neoplastic cells were cyclo-oxygenase-2 and vascular endothelial growth factor positive.

"Inflammatory" changes of the breast can be seen in many different entities ranging from benign self-limited processes, for example puerperal mastitis, to highly aggressive malignant tumors, such as inflammatory carcinoma. While clinically many of these "inflammatory" processes may look alike, there are some characteristics that allow an accurate differential diagnosis and accordingly a correct treatment. A worldwide effort is made everyday to promote breast health awareness, to facilitate prevention, early detection, and effective treatment. Nevertheless, breast cancer still remains as the number one female cancer and as the second cause of death for cancer in women. Physicians involved in the care of female patients are the first line of defense in the battle against cancer. Therefore, it is important to keep in mind a broad differential diagnosis in patients that seek medical attention complaining of a breast problem. Herein is a summary of the most common causes of inflammatory and inflammatory-like changes in breast with special emphasis on clinical presentation and differential diagnosis.

The presence of skin involvement in breast cancer results in the classification of the tumor into the highest tumor category, and accordingly into the highest non-metastatic disease stage (current TNM classification: T4/stage III). This traditional view is no longer justifiable, as tumors that show non-inflammatory skin involvement (T4b) make up a considerably heterogeneous group with a high percentage of small-sized tumors. Classifying all lesions demonstrating this feature together results in the combination of tumors with widely differing prognostic and therapeutic implications into a single group. This violates the basic principle of the TNM concept in that only tumors exhibiting similar extension and prognosis should be grouped into one category/stage. Furthermore, the currently valid definitions of non-inflammatory skin involvement are misconceived for the substantial group of small tumors which often have ambiguous morphologic findings: the clinical classification depends on the subjective perception of the individual observer, and the pathologic staging considers histologic criteria that are not justifiable from a functional-morphological point of view. For these reasons, we strongly feel that there is a need to revise the current T4 category. We recommend that breast carcinomas currently classified as T4a-c should be eliminated from the T4 category and classified simply according to their tumor size (T1-3). The prognostically very unfavorable inflammatory carcinoma (T4d) should be maintained as the only clinicopathologic entity in the T4 category. This proposal, which will also lead to a revision of the stage III group, adheres more closely to the goals and principles of the TNM classification than do the current classification guidelines. Through the revision of the T4 category, the definitions and guidelines of inflammatory breast carcinoma should be adapted to the internationally accepted nomenclature.

Inflammatory breast carcinoma is an extremely rare, rapidly progressive breast carcinoma which is a great masquerader and often is mistaken as an inflammatory lesion. This leads to the delay in diagnosis. Here, we report such a case where the mistaken clinical diagnosis led to it being treated with antibiotics. However, fine-needle aspiration cytology of the case saved the day. Histopathological confirmation followed by multimodal therapy was rendered, and the patient responded well to the treatment. Thus, awareness and recognition of this rare entity, which mimics various inflammatory and nonmalignant causes, is of paramount importance for the doctors and patients alike.

Inflammatory breast cancer is a rare highly malignant form of breast cancer. Clinical signs and symptoms with histologic examination usually confirm the diagnosis. There are rare reports of breast edema of congestive heart failure which were difficult to differentiate from inflammatory carcinoma. The differential becomes more difficult when congestive heart failure is associated with unilateral breast edema. We present a case of a 70-year-old woman with congestive heart failure associated with unilateral breast edema and skin thickening simulating inflammatory breast carcinoma on mammography.

Our goal was to describe the mammographic characteristics of primary inflammatory carcinoma of the breast.We identified the medical records of 43 women who participated in a chemotherapy protocol for primary inflammatory carcinoma of the breast between 1994 and 1997. Mammograms were available for review in 26 women (age range, 34-78 years; mean age, 56 years). Two radiologists independently reviewed the 26 mammograms obtained before patients underwent treatment. A third observer was the final arbiter when needed.Mammographic findings included skin thickening in 24 patients (92%), diffusely increased density in 21 patients (81%), trabecular thickening in 16 patients (62%), axillary lymphadenopathy in 15 patients (58%), architectural distortion or focal asymmetric density in 13 patients (50%), and nipple retraction in 10 patients (38%). Malignant-appearing calcifications were seen in six patients (23%), and a mass was seen in four patients (15%).Diffuse mammographic abnormalities such as skin thickening, increased density, trabecular thickening, and axillary lymphadenopathy are common at presentation in patients with primary inflammatory carcinoma of the breast. Mammographic masses and malignant-appearing calcifications are uncommon manifestations of this disease.

The applications of bone marrow transplantation for the management of advanced local disease are examined. This review for stage III and inflammatory carcinoma suggests enhanced effectiveness and a progressive decrease in costs for bone marrow transplantation.

Inflammatory carcinoma is a rare and aggressive form of primary epithelial cancer that includes 1–6 % of breast cancer and is associated to a poor prognosis given the high probability of micrometastases at diagnosis; about 20 % of patients have distant metastases at diagnosis [1], with a high incidence of recurrence, higher than those noninflammatory carcinoma.

In a retrospective study the value of MR imaging of the breast in inflammatory changes was evaluated. The signal enhancement of 8 patients with histopathologically verified inflammatory carcinomas and 9 patients with global mastitis as well as local inflamed lesions was analysed. Neither signal behaviour nor signal/time relation were suitable to differentiate between malignant and benign changes. In conclusion inflammatory changes of the female breast are not indicated to be examined with MR imaging.

The aim of the study was to define an effective regimen as induction treatment in chemotherapy naive patients with advanced breast cancer as preparation for ablative chemotherapy. Patients and methods: Patients with focally advanced or metastatic breast cancer (AJCC stage IIIB or IV) received 5-fluorouracil, methotrexate with leucovorin rescue and prednisone, alternating with doxorubicin and vincristine for six cycles. Results One hundred and eleven patients were eligible: All patients were evaluable for toxicity and seventy were evaluable for response. Thirty patients achieved a complete remission (43%) and 24 a partial remission (34%). Hematological toxicity was acceptable, as in 7% of 602 treatment cycles patients were admitted for neutropenic fever. Patients with liver metastases had a higher incidence of leucopenic fever, 32% compared to 15% for all patients, and a 25% incidence of cerebellar neuropathy compared to 9% for all patients. Mucositis more severe than WHO grade I occurred in 8% of cycles. Nausea and vomiting were not severe and cardiac or renal toxicity did not occur. Thromboembolic omboembolic events occurred in 7% of the patients. Conclusions: This induction regimen carries a 43% complete and 77% overall remission rate, which is high compared to other conventional and even escalated regimens. The toxicity profile is acceptable except for the higher incidence of leucopenic fever and the reversible 5-FU cerebellar syndrome in patients with liver metastases.

Inflammatory carcinoma of the breast has been associated with a poor prognosis. Several therapeutic approaches have been under investigation in an effort to improve outcome.This is a retrospective analysis of 179 patients with histologically confirmed inflammatory carcinoma of the breast: 33 treated with irradiation alone, 35 with combined irradiation and chemotherapy, 25 with irradiation and surgery, and 86 with a combination of three modalities.The 5-year disease free survival (DFS) rates were 40% for patients treated with three modalities, 24% for those treated with irradiation and surgery, and 6% for those treated with irradiation alone or in combination with chemotherapy without a surgical procedure. The 10-year DFS rates were 35%, 24%, and 0%, respectively. Cause specific survival (CSS) curves closely follow the same trends. A clearly superior locoregional tumor control was observed in patients who underwent a surgical procedure: 79% with three modalities, 76% with irradiation and surgery, and only 30% with irradiation alone or in combination with chemotherapy. Distant metastasis occurred in 57% of the group treated with triple-modality therapy, 60% of those treated with irradiation plus surgery, and 85% of the patients treated with irradiation alone or in combination with chemotherapy. There was no significant correlation between the type of mastectomy or doses of irradiation and locoregional tumor control or survival. The significant morbidity of the trimodal therapy (10%), although somewhat higher than that of other modalities (3.2%), was acceptable.The addition of mastectomy to irradiation significantly improved locoregional tumor control, DFS, and CSS; differences were statistically significant. The combination of chemotherapy, surgery, and irradiation had a significant impact on locoregional tumor control and incidence of distant metastases compared with surgery plus irradiation, and a lesser impact, although still statistically significant, on DFS and CSS. Further clinical trials are needed to optimize the management of patients with inflammatory breast cancer.

Giagantomastia is a rare disorder known to occur in pregnancy, causing enlargement of the breasts greater than that of gravid enlargement. The histological features of gigantomastia are glandular hyperplasia and an increase of stromal tissue. Illustrated by one documented case, cytomorphology of gigantomastia was misdiagnosed as a phyllodes tumor. We document the cytomorphology of an axillary mass in a gravid woman of 24 years with gigantomastia. She presented in her first trimester with bilateral mastalgia and swelling, nonresponsive to antibiotics. Imaging excluded mass breast lesions and a pituitary prolactinoma. The breasts progressively enlarged, became warm, tender, and developed skin ulcerations and a peau d'orange appearance. Subsequently she developed a mass in her left axilla. On aspiration of the mass, some of the cytomorphological features were suspicious for a metastasis, which correlated well with her clinical features. Careful evaluation suggested cytomorphology to be compatible with benign accessory breast tissue with possible hormone related changes of pregnancy. Histology of the excised axillary mass confirmed this diagnosis. Thus, awareness of this rare condition and careful evaluation is mandatory to avoid misdiagnosis in a similar clinical context. Diagn. Cytopathol. 2011;39:141–143. © 2010 Wiley-Liss, Inc.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign proliferating breast condition. It was first reported in 1986 when Vuitch, Rosen, and Erlandson described nine cases of benign well-circumscribed, breast masses that simulated vascular lesions consisting of mammary stromal proliferations (Vuitch et al. (1986)). Since then there have been few reported cases of PASH in the literature (Taira et al. (2005)). We describe a large PASH, mimicking inflammatory carcinoma in a young lady that was excised with excellent cosmetic results.

Actinomycosis of the breast is a rare inflammatory disease that has been infrequently reported. It can be primary actinomycosis of the breast, when caused by lesions of the mammary skin and secondary, when there is thoracic or pleural infection; it has extremely variable clinical presentations and may simulate mastitis and malignancies such as inflammatory carcinoma. The diagnosis is confirmed by culture and by finding typical actinomycotic colonies. The usual treatment is surgical drainage and intravenous and oral long-term administration of antibiotics. The authors present a case of actinomycosis of the breast in a 12-week pregnant woman who presented a tumor in the left breast.

Background. Canine mammary inflammatory carcinoma (IC) has a grave prognosis. Prognostic factors and treatment data have not been studied extensively. Objective. To describe clinical characteristics, treatment and outcome of dogs with IC, and identify patient-, tumor-, and treatment-related predictors of overall survival. Design. Retrospective study. Animals. 43 client-owned dogs. Procedures. Records of dogs with a clinical diagnosis of IC showing pathological evidence of dermal lymphatic invasion were reviewed. Data on clinical staging, type of treatment, toxicity, response, and survival time were retrieved. Results. Primary IC accounted for 60,5% of cases, whereas secondary IC represented 39,5% of cases. The overall metastatic rate at presentation was 86,0%, with 81,4% of dogs showing distant metastasis. Six of 29 dogs had an abnormal coagulation profile. Sixteen dogs never received treatment, 24 received medical treatment only, 2 underwent surgical excision and medical treatment, and one underwent surgery only. Forty-one of 43 dogs experienced progressive disease, and 2 dogs were stable, never reaching disease-free status. Mean survival for all patients was 60 days (range, 1 to 300 days). The presence of coagulopathies decreased survival of approximately 70% (OR: 0.28, CI 95%: 0.10-0.80, p < 0.05) and the use of adjuvant chemotherapy increased the chance of survival of more than twofold (OR: 2.54, CI 95%: 1.27-5.08, p < 0.01). Conclusions and clinical relevance. IC is biologically aggressive and has a guarded prognosis. Complete staging at presentation, including coagulation profile, is mandatory. Results suggest that medical treatment may improve outcome, thereby supporting its use in dogs with IC.