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MCQ – 88909

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Question

A 55-year-old woman comes to the physician with concerns about swelling and pain in her right breast. Physical examination shows erythema and prominent pitting of the hair follicles overlying the upper and lower outer quadrants of the right breast. There are no nipple changes or discharge. A core needle biopsy shows invasive carcinoma of the breast. Which of the following is the most likely explanation for this patient’s skin findings?
A. Bacterial invasion of the subcutaneous tissue
B.

Obstruction of the lymphatic channels
C.

Infiltration of the lactiferous ducts
D.

Tightening of the suspensory ligaments
Show Answer

Correct Answer � B

Explanation

Answer B) Obstruction of the lymphatic channels

This woman has invasive carcinoma of the breast. The diffuse erythema, edema, and pitting of the skin suggest peau d’orange (skin resembling an orange peel), which supports the diagnosis of inflammatory breast cancer.

Obstruction of the lymphatic channels

  • Obstruction of the dermal lymphatics by malignant tumor cells in inflammatory breast cancer results in localized lymphedema, which manifests as an increase in the size of the breast and the characteristic swollen and pitted appearance of peau d’orange (prominent hair follicle pits). 

  • Further signs include itching and nipple retraction. Even with trimodality therapy (i.e., chemotherapy, radiotherapy, and radical mastectomy) the prognosis is poor, as inflammatory breast cancer spreads early.

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