Telangiectatic metastatic breast carcinoma preceded by en cuirasse metastatic breast carcinoma

Sir, Breast carcinoma is the most common carcinoma in women, and about 25% of patients develop skin metastasis.1 There are eight distinct clinicopathological types of cutaneous metastasis,1 including en cuirasse (sclerodermoid) carcinoma, inflammatory carcinoma (carcinoma erysipelatodes) and telangiectatic metastatic breast carcinoma (TMBC, or carcinoma telangiectaticum). Clinically, en cuirasse carcinoma manifests diffuse morphoea‐like skin lesions, carcinoma erysipelatodes mimics erysipelas, and TMBC manifests lymphangioma circumscriptum‐like papulovesicles. Pathologically, en cuirasse carcinoma is characterized by interstitial infiltration of tumour cells in single rows or an ‘Indian file’ pattern in the dermis with a secondary fibrotic stroma. In carcinoma erysipelatodes, tumour cells are found to plug up many dilated lymphatics in the dermis in association with a perivascular lymphoplasmacytic infiltrate. The erysipelas‐like appearance is caused by capillary congestion. TMBC is characterized by markedly dilated capillaries in the papillary dermis filled with tumour masses and erythrocytes.2 TMBC appears to be very rare. Only a few cases have been reported in the English language literature.3–10 We report a new case of TMBC in a 72‐year‐old woman presenting with an extensive papulovesicular rash of several months' duration on the right arm. She had had breast carcinoma of the right breast which was diagnosed 12 years previously and was treated with modified radical mastectomy without adjuvant therapy. Six years previously, the skin on the right side of the chest and upper right arm became indurated with infiltrating papules. Biopsy of a papule revealed typical features of en cuirasse metastatic breast carcinoma with interstitial infiltration of tumour cells arranged in an ‘Indian file’ pattern. The tumour cells expressed oestrogen and progesterone receptors, and HER‐2/neu protein. The skin lesions improved gradually with hormonal therapy and chemotherapy.