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Pectoralis major
4%
2/48
Breast lobule
2%
1/48
Lymphatics
90%
43/48
Rib
0%
0/48
Extralobular duct
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This patient's malignancy has invaded the lymphatics of the breast creating the appearance of peau d'orange. Peau d'orange is a skin manifestation of underlying breast cancer. It is often a sign of advanced disease and is a poor prognostic indicator. When this finding is present, the malignancy has infiltrated into the lymphatics draining the breast. This results in cutaneous lymphatic edema, which causes swelling. However, the infiltrated skin is tethered by the ligament of Cooper such that it cannot swell, leading to an appearance like orange skin and the characteristic skin dimpling that is seen. Figure A is a patient with the characteristic appearance of peau d'orange. Incorrect Answers: Answer 1,2,4,5: Each of these anatomic structures of the breast can be infiltrated with malignancy; however, it would not result in the characteristic presentation of peau d'orange.
2.8
(5)
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