A 25-year-old lactating multigravida woman presented with a history of an itching papule on her right nipple during the third month of breast feeding, tender swelling of the nipple with fever, aspiration of pus under local practitioner's prescription, discharge from the aspiration site for the next 3 days, healing, feed rejection, stiffness in the affected breast and a palpable lump by the fifth month of the disease. Preoperative diagnosis by fine needle aspiration (FNA) biopsy was suggestive of malignancy. Excised breast tissue with an axillary lymph node of 1 cm size was submitted for histopathological diagnosis.
Images () show the breast measuring 6 cm in diameter with puckering of the areola and nipple (A), the cut surface showing a whitish friable tumorous mass with irregular patches of brown discolouration (B), the section from nipple displaying disrupted lactiferous ducts in the strata under cutaneous glands (C, D), the proximal segments of disrupted ducts transformed into epidermoid cysts (E, F, G), occasionally retaining openings on the skin surface plugged by keratin, and distally extending into a tortuous branching/terminating sprout lined by lactiferous cells (E, F), distal disrupted segment(s) presenting proximally as an extending reparative lactiferous sprout and the parent duct having intraduct epidermoid carcinoma (H, I) or epidermoid metaplasia (J) and apocrine change (K).
Images from the surface and cut surface of the breast and sections of nipple 175×125 mm (300 DPI).
Sections from the tumour beyond the nipple () displayed a widespread benign lobular adenotic neoplasm comprising of periodic acid–Schiff (PAS) stain-positive lactating acini (A) and non-secretory acini showing apocrine change with desquamation (B), foci of intraduct (C) and intraductular (D) carcinoma comprised of large polygonal PAS-positive cells morphologically similar to the PLE cells,2
minute foci of apocrine change and desquamation in the intraduct carcinoma producing irregular or cribriform luminal spaces (E), argyrophillic fibrils radially arranged at the intraduct carcinoma periphery or forming patches in the central area (E, F), foci of lobular lactating carcinoma with abundant PAS-positive secretion and cuboid columnar secretory cells (G, H), foci of comedo lined by very small carcinoma cells of neurocrine appearance (I) and lobular carcinoma having PAS-negative argyrophillic cuboid columnar papillary component identified as primitive neuroendocrine carcinoma (PNEC) or (J, K), axillary lymph node with metastasis of lactating carcinoma (L).
Images from sections of the tumour beyond the nipple 175×125 mm (300 DPI).
Sections from the brown patchy areas () showed lobular carcinoma presenting polygonal cells intermingled with myoepithelioid and tumour giant cells (M, N, O, P) qualifying the lesion as myoepithelioid granulomatous or giant cell carcinoma. A cytosmear verified differentiation of myoepithelioid/histioid cells among the polygonal carcinoma cells (Q). The myoepithelial carcinoma component presented with productive fibrosis (R). At the lobular periphery polygonal carcinoma cells were seen transforming into exfoliating stellate myoepithelial cells with giant cell variants and fibrous cells, reducing the lobular neoplasm into islands without basement membrane amid the expanding pool of derivative myoepithelioid granulomatous carcinoma (S, T). Collecting ducts with intraduct carcinomas identifiable in lobular areas also displayed transformation of polygonal carcinoma cells to myoepithelioid cells (U), which lacked longitudinal orientation3
and were arranged circumferential to the long axis of duct, displayed hyperchromatic fused binucleate (chromosome shaped) or stellate pleomorphic nuclei and exfoliated forming a myoepithelioid granulomatous carcinoma component (V, W), at places presenting as sclerosing nodules around the intraduct carcinoma (X).