Author Affiliations:Departments of Surgery (Drs Roland and Teal) and Pathology (Dr Schwartz), George Washington University, Washington, DC.
A 49-year-old woman from India presented with a 1-month history of a fungating, ulcerated, bleeding mass involving her entire left nipple (Figure). She had no prior breast pathological findings, surgery, radiation exposure, or trauma. There was no abnormality of the right breast. There was no palpable supraclavicular, infraclavicular, or axillary lymphadenopathy. A bilateral mammogram was obtained, which revealed increased density at the 5-o’clock position of the left breast with skin thickening and prominence of the nipple-areola complex. There were coarse benign-appearing calcifications throughout the left breast. The right breast contained scattered fibroglandular elements. Ultrasonography of the left breast demonstrated diffuse edematous changes. An incisional biopsy of the nipple demonstrated pseudoepitheliomatous hyperplasia and squamous metaplasia of the lactiferous ducts with severe cytologic atypia.
Fungating, ulcerated, bleeding mass involving the entire left nipple.
A. Paget disease of the breast
B. Inflammatory breast cancer
C. Basal cell carcinoma
D. Squamous cell carcinoma
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The Rational Clinical Examination
3. Loss of Fluid From the Intravascular to Extravascular Space, Namely, Ankle or Sacral Edema and Ascites
The Rational Clinical Examination EDUCATION GUIDESAscites
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