QUIZ. What is your diagnosis?

A 60-year-old woman was admitted to the 1st Chair of General, Oncological, and Gastrointestinal Surgery, Jagiellonian University Medical College, because of the diagnosis of an invasive ductal carcinoma of her left breast. At physical examination no palpable tumor in the breast was revealed, but the nipple was inverted and surrounded by a pigmented area of the skin. According to the patient’s statements, the nipple had been inverted for the last five years. The family history did not reveal any contributory cases. Mammography showed a tumor in the left breast, sized 15 mm, surrounded by areas of microcalcifications up to 110 mm in the largest dimension. Ultrasonography of the left axilla revealed a lymph node suspicious for metastatic disease, but the cytological examination was negative for atypical cells. Because of the extent of mammographically detected lesions the patient was qualified for simple mastectomy with sentinel lymph node biopsy.

Macroscopically a tumor in the upper inner quadrant of the breast was seen, sized 14 mm in the largest dimension; its contour was irregular. The nipple was inverted and surrounded by a pigmented area, irregular in contour and pigmentation, diameter 2 cm.

Microscopic images of routine HE staining of the tumor (Fig. 1) as well as the nipple lesion (Figs. 2-4) are shown.