1995: Inflammatory breast cancer.
Am Surg 1995 Feb;61(2):121-4, Glass, JL, et al.
“Inflammatory breast cancer has historically carried a poor prognosis. This has led to the development of multimodal protocols in an attempt to improve survival. Twenty-three women were treated for inflammatory breast cancer at our institution between 1979 and 1992. The mean age at diagnosis was 55.8 years (40 to 77 years). Eighteen women (78%) presented clinically with an erythematous or swollen and tender breast, and 19 (80%) had pathologically demonstrated dermal lymphatic invasion. Five (21.7%) had evidence of distant metastasis at the time of presentation. Treatment consisted of modified radical mastectomy in 65% of patients in combination with preoperative or postoperative chemotherapy. The most common chemotherapeutic regimen was 5-Fluorouracil, Adriamycin, and Cyclophosphamide. Eleven women (48%) also received chest wall irradiation (4,200 to 6,000 cGy). Eleven women had classic multimodality therapy (surgery, chemotherapy, and radiation therapy). Median survival is 23.4 months (6 to 77 months). We concluded that with combination therapy, selected patients can experience long-term survival; however, overall prognosis remains poor, with eventual disease recurrence and death resulting from the disease.”
1995: Spontaneous recurrent tumor lysis syndrome in breast cancer.
Am J Clin Oncol 1995 Feb;18(1):71-3, Sklarin, NT, et al.
“A case of spontaneous recurrent acute tumor lysis syndrome is presented in a woman with inflammatory breast cancer. The occurrence of tumor lysis syndrome in solid tumors is unusual, and spontaneous cases are rare. This and other unusual aspects of this case are discussed.”
1995: Meningeal carcinosis: early clinical manifestations of inflammatory cancer of the breast.
Minerva Med 1995 Jul-Aug;86(7-8):319-22, Pandolfi, C, et al.
“Inflammatory carcinoma of the breast accounts for only 1-6% of mammary cancer in Caucasian women and is characterized by a poor prognosis; distant metastases frequently appear in fact in an early stage of disease and moreover metastatic spreading follows unpredictable ways. In this study we report on a case of a female patient in whom persistent signs of increased intracranial pressure, following the diagnosis of inflammatory carcinoma of the breast, have been referable to the tumour seeding the meninges in the absence of systemic disease. This peculiar and unusual form of neoplasia is up today a challenge for the clinician, both because of therapeutic difficulty and of unexpected metastases which, in turn, worsen the prognosis. Particularly, in our opinion, meningeal localization must be suspected even in the absence of distant metastases.”
1995: Inflammatory carcinomas of the breast: a clinical, pathological, or a clinical and pathological definition?
Int J Cancer 1995 Aug 9;62(4):382-5, Bonnier, P, et al.
“Some controversy remains about the clinical or pathological definition of the different types of inflammatory breast cancer (IBC) and especially the diagnostic and prognostic value of dermal lymphatic involvement. Our purpose was to classify the different types of IBC for which diagnosis was confirmed intraoperatively and ascertain features allowing reliable diagnosis. We studied clinical findings, biological data, and treatment outcome in a series of 144 successive patients. Our results suggest that there are 2 biologically different entities i.e., true IBC and pseudo-IBC. True IBC, whose course is currently fatal in all cases, can be divided into 2 sub-categories i.e., common true IBC (75.7% of cases), in which inflammatory signs occur primarily or secondarily, and occult true IBC (13.2% of cases). Dermal emboli have been observed in 61% of common true IBC, but their absence did not alter the rapidly unfavourable outcome. Extensive lymph-node involvement, other biological features and survival were the same in the 2 sub-categories. Pseudo-IBC (11.1% of cases) can easily be confused with common true IBC. The biological characteristics of pseudo-IBC differ from those of true IBC: no dermal lymphatic involvement and little or no lymph-node involvement. Despite large tumour size, outcome was particularly favourable. It is of great importance to differentiate true and pseudo-IBC, for which the treatments are different. Confirmation of true IBC requires pathological demonstration of dermal lymphatic emboli or extensive lymph-node involvement. Occult IBC must be identified for patients presenting rapidly growing tumours.”
1995: Differentiating inflammatory breast cancer from acute mastitis.
Am Fam Physician 1995 Sep 1;52(3):929-34, Dahlbeck, SW, et al.
“Inflammatory breast cancer is a devastating disease with an extremely high rate of morbidity and mortality. Differentiating this disease from acute mastitis may be difficult on initial diagnosis. The expeditious diagnosis and treatment of inflammatory breast cancer has important ramifications for the patient’s prognosis. Unfortunately, no clear guidelines are available to help the primary care physician differentiate between acute mastitis and inflammatory breast cancer. We present our recommendations and guidelines for a diagnostic approach to this problem. Inflammatory breast cancer typically occurs in older women, while acute mastitis usually affects younger, lactating women. If a trial of antibiotics does not decrease the signs and symptoms in the inflamed breast, inflammatory breast cancer must be considered, especially in older, nonlactating women.”
1995: Inflammatory breast carcinoma.
Surg Oncol 1995;4(5):245-54, Chambler, AF, et al.
“Inflammatory breast cancer (IBC) is a rare subtype of breast cancer traditionally associated with an extremely poor prognosis. The appearance of the effected breast can be misleading, with the incorrect diagnosis of an infective process, rather than a malignant disease, further delaying treatment. Compared with the results achieved by monotherapy with either surgery, radiotherapy or chemotherapy; multimodality treatments have achieved significant improvements in both disease-free and overall survival. The purpose of this article is to provide a comprehensive review of the current literature and highlight those areas where potential advances in the overall management of IBC have been made.”
1996: Inflammatory breast cancer.
Surg Clin North Am 1996 Apr;76(2):411-29, Lopez, MJ, et al.
Multimodal therapy with induction chemotherapy has improved significantly local disease control and overall survival in patients with IBC. This is now considered standard therapy for patients with this disease. Although survival has been improved, well over 50% of these patients will succumb to this disease. Ongoing and future investigations may better define the optimal approach for local control, the optimal duration of maintenance chemotherapy, and the possible role of biologic response modifiers and growth factors in further improving the outcome for patients with this disease.
1996: Postsurgical changes of the breast that mimic inflammatory breast carcinoma.
Mayo Clin Proc 1996 Jun;71(6):552-5, Loprinzi, CL, et al.
“OBJECTIVE: To characterize a clinical syndrome that occurs in some women who have undergone breast or axillary lymph node biopsy or partial mastectomy. MATERIAL AND METHODS: Six case reports are presented, the clinical and histopathologic findings are described, and the implications for recognition of this entity are discussed. RESULTS: Patients who had undergone partial mastectomy, breast biopsy, or axillary lymph node excision shortly thereafter had clinical signs (most notably, erythema and edema) suggestive of infectious mastitis or inflammatory breast cancer. Representative histologic sections of involved skin revealed dilated dermal vessels without specific evidence of infection or cancer. Although antibiotic therapy was generally ineffective, the clinical findings resolved with time (from 2 months to 1 year). This condition should be considered in the differential diagnosis when this circumscribed patient population has such intervention-related symptoms. CONCLUSION: This clinical syndrome may mimic an infectious or neoplastic process, but we hypothesize that it is due to interruption of lymphatic vessels. Appropriate recognition may alter the use of antibiotic therapy or surgical intervention.”
1996: Inflammatory breast cancer: the evolution of multimodality treatment strategies.
Semin Surg Oncol 1996 Sep-Oct;12(5):352-63, Gradishar, WJ
“Inflammatory breast cancer is an aggressive subtype of invasive breast cancer. Early attempts to control the disease with local treatment modalities alone had a minimal impact on survival. More recently, multimodality treatment approaches that integrate systemic chemotherapy, surgery, and radiotherapy have resulted in improved local disease control and prolonged survival. Better systemic therapies need to be developed since metastatic disease develops in the majority of patients.”
1996: Fine-needle aspiration of inflammatory carcinoma of the breast.
Diagn Cytopathol 1996 Dec;15(5):363-6, Dodd, LG, et al.
“Inflammatory carcinoma of the breast is an uncommon clinicopathologic entity which is characterized by a distinctive clinical appearance and poor prognosis. Histopathologically, it is characterized by plugging of dermal lymphatics with tumor emboli. Because this lesion usually does not form a discrete palpable mass, it is not as amenable to diagnosis by fine-needle aspiration (FNA) as other breast lesions. In the following, we report our experience with establishing the diagnosis of inflammatory carcinoma by FNA. Three patients underwent FNA for confirmation of clinically suspected inflammatory carcinoma. All aspirations were performed by a cytopathologist and required multiple passes to obtain diagnostic material. Aspirates were paucicellular and contained fragments of fibrous or adipose tissue. Malignant cells were predominantly distributed in tight, three-dimensional clusters and were identifiable as tumor cells based on large size, nuclear irregularity, and increased nuclear to cytoplasmic ratio. Unlike aspirates from conventional breast carcinoma, individual dispersed cells and cellular discohesiveness were not prominent features. Subsequent histologic material from these patients revealed the characteristic tumor emboli plugging dermal lymphatics. We conclude that in the appropriate setting, the diagnosis of inflammatory carcinoma can be established by FNA.“
