Superior vena cava syndrome presenting as bilateral breast enlargement with “peau d’orange” skin changes

Abstract

A 51 year old female with significant medical history of end stage renal failure presented with bilateral tender breast enlargement, “peau d’orange” skin changes and bilateral axillary lymphadenopathy. The patient was initially diagnosed with mastitis, and underwent a course of antibiotics with minimal improvement. Extensive imaging and repeated biopsies demonstrated benign breast tissue without malignancy. Punch biopsies of breast skin raised a broad differential diagnosis including neoplasm, fibrosing mediastinitis and superior vena cava obstruction. Immediately following the pathology report which included this differential, a superior vena cava (SVC) occlusion with venous stenotic impairment of lateral cephalic outflow was detected. The patient was then treated with resolution of her symptoms. In this case, SVA occlusion was raised based on the patient’s history of chronic renal dialysis requiring multiple catheter placements and by increasing bilateral tender breast enlargement, “peau d’orange” skin changes and histology of lymphedema. We herein describe an unusual case in which the dermatopathologist made the initial awareness of SVA occlusion by seeing lymphangiectasia and stromal edema on a patient with bilateral breast enlargement.