This 54-year-old woman complained of an itchy patch on her right nipple for 4 months. Scratching resulted in thickening of the overlying skin and intermittent drainage of serosanguinous fluid. Application of topical antiseptics did not help with symptoms. Examination revealed eczematous changes over the nipple and an ill defined nodule in the lower lateral quadrant. Scrapings from the nipple area also revealed a few similar atypical cells. The fine needle aspirate cytology was confirmed by biopsy.
Panel A shows the eczematous changes overlying the right nipple. Panels B-D show the results of fine needle aspirate cytology with a highly cellular smear with large atypical ductal epithelial cells arranged in clusters and also in discohesion. The cells have large nuclei and irregualr nuclear membranes. There is moderate cytoplasm with well defined cell borders. There are no naked nuclei in the background.