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2. Sentinel node excision:<br> | 2. Sentinel node excision:<br> | ||
Seven lymph nodes negative for malignancy (0 / 7). | Seven lymph nodes negative for malignancy (0 / 7). | ||
== DCIS in papilloma == | |||
===Microscopic=== | |||
The specimen is a surgical biopsy for a right breast mass, that was previously biopsied. | |||
The sections show an intraductal lesion with fibrovascular cores, epithelial proliferation and mild nuclear atypia. There is no necrosis and no mitotic figures are identified. | |||
Two small foci of atypical, nested epithelial cells (~ 1 mm) are present at the edge of the lesion and adjacent to tissue with biopsy changes (cholesterol clefts, fibrosis, fat necrosis). | |||
The surrounding breast has cystic glandular dilation with apocrine change, and fibroadenomatoid changes. There is also epithelial hyperplasia with cellular streaming, slit-like spaces in the gland periphery, and bland nuclei. | |||
Evaluated with immunostains: | |||
Positive: ER strong-diffuse (nucleus), p63 strong (nuclear), SMMS (cytoplasmic). | |||
Negative: CK5/6. | |||
Comment: The lesion represent a papilloma with low-grade DCIS and epithelial displacement in association with biopsy changes. The two foci of epithelial displacement morphologically resemble microinvasive carcinoma, which would be managed the same way. | |||
===Final diagnosis=== | |||
Breast, right, surgical biopsy:<br> | |||
Papilloma with: | |||
(1) Ductal carcinoma in situ (DCIS) – solid pattern, grade 1/3, | |||
(2) Partial hyalinization, | |||
(3) Epithelial displacement / biopsy artifact, | |||
- lesion completely excised.<br> | |||
Surrounding breast: | |||
Focal fibroadenomatoid change, | |||
Florid epithelial hyperplasia, | |||
Fibrocystic changes with apocrine metaplasia. |
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