Contributed by Franklin Sedarat, MD, Rovena L Kessinger, MD, David J. Dabbs, MD
Published on line in December 2002
The patient was a 64-year-old female with left nipple discharge and an inverted nipple. The patient stated that left nipple retraction was chronic for many years, and described crusting of the left nipple. Digital diagnostic mammogram showed calcifications in the anterior left breast, some vascular, some coarse benign-appearing and others punctate benign-appearing. There were also benign-appearing calcifications in the anterior right breast. Ultrasound of the left retroareolar area revealed a focally dilated duct at 5 o'clock with abrupt termination of dilation approximately 2 cm from the nipple. No intraductal mass was identified. Consequently, punch biopsy was done at 3 o'clock left nipple to further evaluate the lesion.
The specimen consisted of 0.3 cm white rubbery skin, with 0.3 cm of underlying subcutaneous tissue with no discrete gross lesion.
MICROSCOPIC DESCRIPTION: (Figs. 1, 2, 3, and 4)
Large round/oval cells were observed with ample pale cytoplasm, round nuclei, and distinct nucleoli dispersed singly or in clusters within the surface epithelium. Some infiltrating cells appeared to lie in vacuoles. There was a marked lymphoplasmacytic infiltrate in the superficial dermis. Immunohistochemical stains performed revealed positivity for CK7 (Fig. 5) and HER2/Neu (Fig. 6), negativity for CEA, GCDFP (gross cystic disease fluid protein) and S-100.