A 75-year-old woman with a history of infiltrating ductal carcinoma of the breast (previously treated with bilateral radical mastectomy and ongoing adjuvant hormonal therapy) presented to the dermatology clinic with a 1-year history of rash on the chest. Physical examination and histopathology of a skin-biopsy sample from the left chest-wall scar are shown. What is the most likely diagnosis?
一位75岁女性,有乳腺浸润性导管癌病史(曾接受双侧根治性乳房切除术,目前正在进行辅助激素治疗),因胸部皮疹1年就诊于皮肤科门诊。图中展示了体格检查结果以及左胸壁瘢痕处皮肤活检样本的组织病理学检查结果。最可能的诊断是什么?

A. Cellulitis蜂窝织炎
B. Cutaneous metastases皮肤转移瘤
C. Eosinophilic fasciitis嗜酸性筋膜炎
D. Erysipeleas丹毒
E. Post-mastectomy scar granuloma乳房切除术后瘢痕肉芽肿
答案解析:
组织病理学检查显示真皮淋巴管内有大的异型细胞。免疫组织化学染色显示,标本大汗腺分泌蛋白15(GCDFP – 15)和GATA3呈阳性。最终诊断为乳腺癌皮肤转移。对于有乳腺癌病史的患者,皮肤转移可能意味着疾病已进展至晚期,在评估表现为类似丹毒或蜂窝织炎的皮疹时,应将皮肤转移纳入鉴别诊断。
正确答案:B
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