PMC6031089_01
A wedge biopsy was taken from the nipple which appeared to have a 2.2 cm lesion.
CRIDM2018-1984593.001.jpg
PMC6031089_01_CRIDM2018-1984593.001.jpg
fig1
A wedge biopsy of the nipple was performed to confirm the initial shave biopsy pathology (Figure 1).
Histologic examination of a large section of tissue at 10x magnification (a) demonstrates the verrucoid top of the lesion and the invasive deep edge. Wide nests of tumor cells can be seen invading as well as a desmoplastic reaction to the nests and the lymphoplasmacytic host response. A low power image of the verrucous surface at 4x magnification (b) shows the verrucous surface with peaking hyperkeratosis and subtle koilocytotic changes. A high power image at 20x (c) shows dissolution of the basal lamina and invasion of the dermis. There is invasion by a small cluster of keratinocytes with the expected lymphoplasmacytic host response and desmoplastic host response (samples stained with hematoxylin and eosin).
CRIDM2018-1984593.002.jpg
PMC6031089_01_CRIDM2018-1984593.002.jpg
fig2
On final histologic examination, the lesion was found to be a large tumor with verrucous features, hyperkeratosis, dyskeratosis, and nests of keratin pearl formation (Figure 2).