PMC4573407_01
Mammogram of the left breast shows irregular spiculated calcifications in a retroareolar distribution on both compressed views.
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A 68-year-old female was referred with suspicious clusters of 2.5 x 5.5 cm calcifications in the retroareolar left breast on mammogram (Fig. 1) and an unremarkable ultrasound.
Excision biopsy of left breast lesion. Photomicrograph of haematoxylin and eosin stained slide at low (A), medium (B) and high (C) magnifications show a focal nodular lesion (A) with compressed duct-like structures (*) surrounded by fibrotic stromal cells (#) (B) admixed with proliferating atypical squamous metaplastic cells ( ) and lymphocytic infiltration (^) (C).
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Histopathology identified mildly proliferative fibrocystic changes with duct hyperplasia, sclerosing adenosis, apocrine metaplasia, fibroadenomatoid nodules and multiple intraductal papillomas with a focal nodular lesion composed of proliferating squamous metaplastic cells with compressed duct-like structures surrounded by fibrotic stromal cells [Fig. 2A-C], diagnosed as syringomatous adenoma of the nipple with no evidence of invasive/in-situ carcinoma.
Right breast central mastectomy. Photomicrograph of haematoxylin and eosin stained slide at low (A), medium (B) and high (C) magnifications show a complex sclerosing lesion (A) with infiltrating duct-like structures (*) (B) and single infiltrating atypical squamous cells with metaplastic squamous cells lining the ducts ( ) (C).
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Histopathology confirmed low-grade adenosquamous carcinoma of the right breast with atypical infiltrating metaplastic squamous cells surrounded by stromal lamellar fibrosis and lymphocytic aggregates in the background of a complex sclerosing lesion (Figure 3A-C).
Left breast central mastectomy. Photomicrograph of haematoxylin and eosin stained slide at low (A), medium (B) and high (C) magnifications show similar features of infiltrating atypical squamous cells in the background of dense stromal lamellar fibrosis and lymphocytic aggregates.
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The residual left breast tissue showed similar features supporting the presence of bilateral LGASC (Fig. 4A-C).