A 45-year-old woman presents with diffuse erythema, peau d'orange appearance, and warmth of the entire right breast over 2 weeks. No discrete mass is palpable. Skin biopsy shows dermal lymphatic tumor emboli. Which is the correct TNM classification and management?

• A T4d N0-3 M0 (inflammatory carcinoma); neoadjuvant chemotherapy first ✓
• B T1N0M0; upfront modified radical mastectomy
• C TisN0M0; wide local excision with sentinel node biopsy
• D T2N1M0; upfront surgery followed by adjuvant chemotherapy

Explanation

Inflammatory breast carcinoma (T4d) presents with diffuse erythema, peau d'orange, and warmth due to dermal lymphatic tumor emboli. It is a clinical diagnosis, not requiring a discrete mass. It is always stage IIIB or higher at presentation. Management is neoadjuvant chemotherapy followed by mastectomy and radiation, not upfront surgery. It is aggressive with poor prognosis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.