{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:35:43Z","timestamp":1758634543818},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2006,10,24]],"date-time":"2006-10-24T00:00:00Z","timestamp":1161648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2007,3]]},"abstract":"<jats:p>A 50\u2010year\u2010old Caucasian woman with a history of esophageal adenocarcinoma presented with a 3\u2010week history of right breast swelling and progressive erythema. Twenty\u2010two months prior to presentation, she had been diagnosed with adenocarcinoma of the esophagus (T3,N1,M1a) and underwent neoadjuvant chemoradiotherapy followed by surgical resection.<\/jats:p><jats:p>On physical examination, the right breast was red, swollen (40% larger than the contralateral breast), tender to palpation, and warm to the touch (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f1\">Fig.\u00a01<\/jats:ext-link>). No mass was palpable. On the basis of the clinical findings, inflammatory breast carcinoma was suspected. A punch biopsy revealed a poorly differentiated adenocarcinoma with extensive involvement of dermal lymphatics (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f2\">Fig.\u00a02<\/jats:ext-link>). The clinical and histologic differential diagnosis included inflammatory breast carcinoma vs. metastatic esophageal adenocarcinoma to the skin of the breast.<\/jats:p><jats:p><jats:fig><jats:caption><jats:p>The affected breast resembled inflammatory breast carcinoma with erythema and prominent edema. The edema resulted in partial inversion of the nipple<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD3113:IJD_3113_f1\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p><jats:fig><jats:caption><jats:p>Within the reticular dermis and dermal lymphatics, there was a poorly differentiated adenocarcinoma. Many of the tumor cells had a signet ring morphology (hematoxylin and eosin, \u00d7200)<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD3113:IJD_3113_f2\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p><jats:p>To resolve this question, immunohistochemical stains for estrogen and progesterone receptors and CDX\u20102 (BioGenex, San Ramon, CA, USA) were performed. <jats:italic>CDX\u20102<\/jats:italic> is an intestinal homeobox gene expressed in gastrointestinal epithelium and gastrointestinal tumors. The tumor nuclei were positive for CDX\u20102 but negative for both steroid receptors (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"#f3\">Fig.\u00a03<\/jats:ext-link>), confirming the diagnosis of metastatic esophageal adenocarcinoma.<\/jats:p><jats:p><jats:fig><jats:caption><jats:p>The tumor cells had strong nuclear immunoreactivity for CDX\u20102 (CDX\u20102 immunohistochemical stain, \u00d7400)<\/jats:p><\/jats:caption><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:00119059:media:IJD3113:IJD_3113_f3\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>","DOI":"10.1111\/j.1365-4632.2006.03113.x","type":"journal-article","created":{"date-parts":[[2006,10,24]],"date-time":"2006-10-24T16:13:27Z","timestamp":1161706407000},"page":"303-305","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Metastatic 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