Cancer under the guise of a skin disease. The patient's history.

News 01/28/2020

The experts of the Mammological Center "Women's Health Clinic" were contacted by the patient M., 60 years old. 5 years ago, she noticed changes in her breast skin. All this time, the woman is observed in a skin and venereal dispensary, undergoes treatment. During the studies (mammography and ultrasound) at the place of residence, nodular formations were not detected by doctors. At the reception in our Clinic, she complained of redness of the left breast.

During the examination, the doctor saw swelling of the left breast and overflow of blood vessels (hyperemia). The patient's skin was bleeding and ulcerated in places. The lymph nodes were not enlarged. At the same time, the specialist could not clearly palpate the nodular formations. 

To clarify the diagnosis, the doctor sent the Muscovite for additional examinations in our center.

Mammography showed:

- Thickening of the skin on the left.

- Changes (involutions) of breast tissue against the background of a natural physiological process, when glandular tissue is gradually replaced by fat cells against the background of age-related hormonal changes. In the lower parts, the radiologist saw a formation with indistinct contours measuring 10x8 mm. In the axillary area on the left, the specialist determined that the lymph node was enlarged to 15 mm. According to the classification of neoplasms, the mammologist established the category of BIRADS 4b.Ultrasound examination showed:

- The blood vessels of the circulatory system are overflowing with blood (hyperemic), the skin is thickened to 4-5 mm and swollen in the central parts with ulceration.

- In the upper-inner quadrant closer to the sternum, the specialist diagnosed a 9x9x8 mm formation with increased blood flow and enlarged lymph nodes in the axillary region on the left with dimensions of 16x11 mm and 12x7 mm. According to the classification, the category BIRADS5 is set.According to the radiological examination methods, the doctor made a preliminary diagnosis: suspected cancer of the left breast with metastases to the axillary lymph nodes on the left.  On this basis, a specialist mammologist referred patient M. for a trepanbiopsy of the formation. As a result of the examination, an invasive non-infected cancer of grade 3 malignancy, Her-2neu-positive subtype, cT4bN0M0, was confirmed.

The clinical case is interesting because inflammatory changes in the skin can distract the doctor's attention from the oncological process that takes place simultaneously with the skin disease. With an extensive inflammatory process, it is difficult for medical specialists to perform high-quality mammography and ultrasound examinations, which increases the likelihood of missing a malignant formation. In the case of our patient M., mammography at the place of residence showed a false negative result due to the" insidious " deepest (retromammary) location of the malignant formation at the sternum. This localization did not allow the breast to be adequately pulled out during the examination. Also, the formation was missed during ultrasound due to the extensive and painful inflammatory process at the time of the study. After the patient was treated for a skin disease and its symptoms subsided somewhat, experienced mammologists were able to re-perform diagnostic procedures in full, which finally revealed the presence of a malignant formation.

You can make an appointment for a consultation with a specialist of the Mammological Center "Women's Health Clinic" by calling 8 (495) 305 34 50 or by yourself, choosing your free time in the electronic schedule on our website.

Be healthy!

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