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Special Feature
July 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Departments of Surgery (Drs Roland and Teal) and Pathology (Dr Schwartz), George Washington University, Washington, DC.



Arch Surg. 2007;142(7):687. doi:10.1001/archsurg.142.7.687

A 49-year-old woman from India presented with a 1-month history of a fungating, ulcerated, bleeding mass involving her entire left nipple (Figure). She had no prior breast pathological findings, surgery, radiation exposure, or trauma. There was no abnormality of the right breast. There was no palpable supraclavicular, infraclavicular, or axillary lymphadenopathy. A bilateral mammogram was obtained, which revealed increased density at the 5-o’clock position of the left breast with skin thickening and prominence of the nipple-areola complex. There were coarse benign-appearing calcifications throughout the left breast. The right breast contained scattered fibroglandular elements. Ultrasonography of the left breast demonstrated diffuse edematous changes. An incisional biopsy of the nipple demonstrated pseudoepitheliomatous hyperplasia and squamous metaplasia of the lactiferous ducts with severe cytologic atypia.

Fungating, ulcerated, bleeding mass involving the entire left nipple.

Fungating, ulcerated, bleeding mass involving the entire left nipple.

What Is the Diagnosis?

A. Paget disease of the breast

B. Inflammatory breast cancer

C. Basal cell carcinoma

D. Squamous cell carcinoma