Thickened Skin Syndrome of the Breast

VII Thickened Skin Syndrome of the Breast

This is a syndrome produced by lymphedema, usually secondary to obstruction of the axillary lymphatics (see Fig. XXIX).

Fig. XXIX Thickened skin syndrome: thickened skin over much or all of the breast, associated with increased density and a reticular pattern.

Physical Examination

• The affected breast is larger and heavier due to increased fluid content.

• There is obvious peau d’orange.

• Enlarged axillary lymph nodes are frequently palpable.

• The skin is inflamed in the so-called inflammatory carcinoma, in acute mastitis, and frequently in abscesses.

Mammographic Appearance

(Cases 153 and 154)

• The skin is obviously thickened, often many times normal thickness. This occurs initially and to the greatest extent in the lower, dependent portion of the breast.

• The overall density of the breast is increased due to its high fluid content. In comparison to the other breast, there is a coarse reticular pattern on the mammogram.

Causes of Lymphedema

Lymphedema may be caused by the following:

• axillary lymphatic obstruction blocking lymphatic drainage of the breast. This may be secondary to:

—breast carcinoma metastases. An aggressive carcinoma may spread throughout the breast and axilla (Case 153). A carcinoma may also be located high in the axillarytail and metastasize directly to the axillary lymph nodes

—primary malignant lymphatic diseases (lymphomas, etc.)

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