Abstract:

Carcinoma en cuirasse (CeC) is a rare form of metastatic cutaneous carcinoma, typically associated with prior treatment of breast cancer. While data is limited on the chronology between initial breast cancer diagnosis and later presentation of CeC, most documented cases have occurred within three years of initial cancer treatment. To our knowledge, this is the first reported case of CeC presenting after more than ten years of initial breast cancer diagnosis. A 77-year-old female presented for evaluation of intensely pruritic lesions of one year on her anterior trunk. She had a remote history of infiltrating ductal breast carcinoma, diagnosed in 2007. At that time, she was treated with a bilateral mastectomy and a course of tamoxifen but was lost to follow-up. Physical examination demonstrated sclerodermoid-like, indurated, and hyperpigmented plaques that were studded with pink papules and overlying scale. The lesion characteristics raised suspicion for cutaneous metastasis, with other differential diagnoses including Majocchi’s granuloma, morphea, and tumid lupus erythematosus. Punch biopsy demonstrated a deep dermal interstitial and periadnexal infiltration of relatively bland-appearing cells with atypical nuclei. Immunohistochemical staining was strongly positive for cytokeratin AE1/AE3, estrogen receptor and progesterone receptor. A diagnosis was made of CeC secondary to primary breast cancer, and the patient was referred to oncology. Clinically, CeC first presents as erythematous papules or nodules. As the metastatic cells begin to invade the superficial lymphatic vessels, the lesions develop a sclerotic, morphea-like, and fibrotic appearance. Histopathology of CeC reveals tumor cells organized in lines, known as an “Indian file” pattern. The surrounding tissue is densely fibrotic, with decreased vascularity. The decreased vascularity of the tissue makes treatment of CeC challenging, and there is no gold standard therapy.

Financial Disclosure:
No current or relevant financial relationships exist.

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Sarah Ibrahim, MD