A 59-year-old woman presented with a 1-month history of an ulcerated left nipple. This was associated with an intermittent bloody discharge. The surrounding areola was thickened and indurated. There was no nipple inversion ( Fig. 1).On examination the nipple was slightly erythematous. A 0.5 cm ulcer was located over the lower third of the nipple. A hemoserous discharge was present. There were no palpable breast masses and no associated adenopathy.The lesion was clinically suspicious of Paget's disease of the nipple. The patient had a mammogram that revealed no abnormality and then had a biopsy of the ulcerated area.The biopsy revealed a proliferation of glandular structures suggestive of a benign adenomatous process. The patient then had local curative excision of the lesion. Histology confirmed a proliferation of glandular tissues, all of which were invested by a myoepithelial cell layer (Fig. 2). Figure 2. Double layer of myoepithelial cells investing a proliferation of glandular tissue. Florid intraductal epithelial hyperplasia is also present. (Hematoxylin and eosin; magnification ×40.)Figure 1. Preoperative picture of the ulcerated nipple.
The ability to identify SLNs after formalin fixation increases the ease and applicability of SLN mapping in colorectal cancer. Furthermore, the sensitivity and specificity of this simple ex vivo method for establishing regional lymph node status were directly comparable to those in previously published reports.
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