PMC9173910_01
(a) Clinical appearance of the breast lesion. (b) Clinical appearance of the axillary dissection specimen.
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Examination revealed a 3 x 3 cm raised polypoid lesion at the left periareolar region with palpable left axillary lymphadenopathy (Figure 1(a)).  Figure 1(b) shows the axillary lymph node dissection specimen. Our patient underwent a simple mastectomy with 4 cm gross margins as well as an axillary lymph node dissection up to level II (Figure 1(b)).
(a) Mediolateral oblique mammogram of the left breast showing a circumscribed periareolar opacity (circle) and dense axillary lymph node (arrow). (b) Superficial hypoechoic nodule on left breast sonography. (c) Lymphadenopathy on left axilla sonography.
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Bilateral mammography revealed a 3.7 cm circumscribed opacity at the left periareolar region (Figure 2(a)), while ultrasonography showed a 3.3 x 3.0 x 0.9 cm oval hypoechoic mass (Figure 2(b)) with left axilla lymphadenopathy (Figure 2(c)).
Tumour H&E sections: (a) skin-based carcinoma showing islands of infiltrating tumour (x40); (b) focus of central necrosis (x100); (c) cytoplasmic clearing within tumour islands with nuclear pleomorphism (x100); (d) focus of lymphovascular invasion (x200).
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Histologically, the tumour was poorly differentiated, consisting of infiltrative islands (Figure 3(a)) of solid sheets, nests, and cords of rounded to polygonal cells surrounded by desmoplastic stroma. Areas of necrosis (Figure 3(b)) and keratinisation were observed together with nuclear pleomorphism and conspicuous mitoses (Figure 3(c)). Lymphovascular invasion was identified (Figure 3(d)).
Immunohistochemistry analysis results: (a) ER (-); (b) GATA 3 (+); (c) CK5/6 (+).
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IHC staining was negative for CK7, CEA, ER (Figure 4(a)), PR, and HER2, focally positive for EMA, P16, and GATA3 (Figure 4(b)), and diffusely positive for CK5/6 (Figure 4(c)) and p63.