Classification of cutaneous intravascular breast cancer metastases based on immunolabeling for blood and lymph vessels

Department of Dermatology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Journal of the American Academy of Dermatology (Impact Factor: 4.45). 05/2009; 60(4):633-8. DOI: 10.1016/j.jaad.2008.11.008
Source: PubMed


Intravascular breast cancer metastases to the skin can have several clinically distinct manifestations. Carcinoma telangiectoides, which presents as an erythematous patch with prominent telangiectasias or lymphangioma circumscriptum-like lesions, is a rare manifestation of cutaneous metastatic breast cancer and has been proposed to spread via dermal blood vessels. Carcinoma erysipelatoides, which presents as an erysipelas-like patch or plaque, has been proposed to spread via lymphatics. Clinical variants with nodular lesions that show tumor cells within vessels and in the extravascular space are seen more commonly. It has not been demonstrated conclusively whether dermal blood vessels or whether dermal lymph vessels are principally involved in these clinically distinct forms of cutaneous breast cancer metastases.
We sought to determine if carcinoma telangiectoides affects predominantly dermal blood vessels and if carcinoma erysipelatoides affects predominantly dermal lymph vessels.
Serial sections of biopsy specimens from patients with a characteristic clinical presentation of carcinoma telangiectoides and carcinoma erysipelatoides were labeled for cytokeratin to identify malignant cells. Subsequently, these sections were labeled for CD31 (a marker for blood and lymph vessels) and podoplanin (a marker for lymph vessels, but not for blood vessels), to differentiate blood vessels from lymph vessels in these sections.
Sections from carcinoma telangiectoides showed malignant tumor cells strictly within dermal blood vessels, but not in lymph vessels. In contrast, sections from carcinoma erysipelatoides showed malignant tumor cells strictly in dermal lymphatics.
We used typical clinical cases to demonstrate the distinct involvement of blood and lymph vessels in these variants of cutaneous metastatic breast cancer. A larger case series is needed to confirm these findings.
Immunolabeling for CD31 and podoplanin of cutaneous lesions of metastatic breast cancer confirms the spread of tumor cells predominantly via lymphatics in carcinoma erysipelatoides and predominantly via blood vessels in carcinoma telangiectoides.

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    • "Cutaneous metastases can have different clinical patterns, the most common manifestations are nodules.4,9 Other less common presentations may include ulcers, erythema (carcinoma erysipeloides), plaques, or zosteriform distribution.10–12 "
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    ABSTRACT: Metastatic breast carcinoma can mimic benign cutaneous lesions. Breast surgeons should be aware of skin manifestations to be able to distinguish them and set a proper therapeutic strategy. A clinical case of cutaneous lesion after breast cancer is presented. A 41-year-old woman with a history of left breast cancer underwent a prophylactic right nipple-sparing mastectomy with immediate breast implant reconstruction. After surgery, she attended our service due to a right periareolar rash resistant to medical treatment, accompanied by cutaneous induration and fixed axillary adenopathy. A differential diagnosis of skin metastases was considered. Cutaneous metastases should be the first diagnosis of skin lesions in oncological patients due to the implications in terms of treatment and prognosis. However, differential diagnoses have to be discussed.
    Full-text · Article · Dec 2013
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    • "Most metastases are observed on the chest wall; less common sites include scalp, neck, upper extremities, abdomen and back [3]. In general, eight specific clinical patterns associated with cutaneous breast cancer are known: cancer en cuirasse [4], inflammatory metastatic carcinoma (carcinoma erysipelatodes) [2,5], carcinoma teleangiectaticum [4,6], alopecia neoplastica [7,8], Paget's disease [9,10], breast carcinoma of the inframammary crease [11], metastatic mammary carcinoma of the eyelid with histiocytoid histology [12], nodular metastases [13,14], and mucinous adenocarcinoma metastatic to the skin [2]. Skin metastases from breast carcinoma can also be present in a zosteriform distribution when occurring at the sides of the abdomen [13,15]. "
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    ABSTRACT: Breast cancer is common in women and its metastases involve the skin in approximately one quarter of patients. Accordingly, metastatic breast cancer shown to be cutaneous through histology must be distinguished from a wide variety of other neoplasms as well as the diverse morphologic variants of breast cancer itself. We report the case of a 61-year-old Caucasian woman with cutaneous metastases of a bilateral ductal breast carcinoma that in histopathological examination mimicked an adnexal neoplasm with sebaceous differentiation. Against the background of metastatic breast carcinoma, dermatopathological considerations of sebaceous differentiation of skin lesions are presented and discussed focusing on the rare differential diagnosis of sebaceous carcinoma of the breast.
    Full-text · Article · Sep 2011 · Journal of Medical Case Reports

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