A 65-year-old male with complaints of lump in left breast since 2 years. CT scan findings were non-homogeneous mass in left breast along with bilateral axillary lymphadenopathy. Lumpectomy was performed and diagnosed as infiltrating duct carcinoma breast. After that, we received modified radical mastectomy specimen in our lab. On gross examination, subareolar cavity was surrounded by whitish solid area of 2 cm without involvement of skin. Total 26 lymph nodes were retrieved. Lymph nodes were whitish and fleshy {Fig. 1}. The resection specimen was fixed in formalin, routinely processed and multiple representatives of 3-micron sections were stained with haematoxylin and eosin stain and Immunohistochemistry (IHC) was also performed. Microscopic examination showed the features of infiltrating duct carcinoma NOS: Modified Nottingham Bloom Richardson's Grade II in breast specimen. All the lymph nodes were submitted for processing and H and E stained sections taken from all the submitted lymph nodes showed the complete effacement of lymph node by small lymphocytes having slightly irregular round nuclei. The chromatin was condensed, and cytoplasm was scanty [Fig. 3]. None of the lymph nodes showed any metastatic deposits. Peripheral smear of patient showed features of chronic lymphocytic leukaemia (absolute lymphocyte count was 16400 cells/mm 3) [Fig. 5]. IHC of breast tumour showed ER/ PR positivity with H score of 350 and 240 respectively and HER-2/ Neu protein expression was negative with score of 1+ [Fig. 2]. Lymph nodes were immunoreactive for CD 19, CD 23 and for CD 5. Cells were non-reactive for Cyclin D1 a and CD3 [Fig. 4]. FINAL DIAGNOSIS IDC breast Stage II B with Small lymphocytic lymphoma and chronic lymphocytic leukaemia.
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