Tall cell carcinoma of the breast with reversed polarity (TCCRP) is a rare type of invasive breast cancer with overlapping histopathological features with papillary thyroid carcinoma and a characteristic immunohistochemical (IHC) and molecular profile. Case Presentation: A 72-year-old female presented with a left breast mass and purulent nipple discharge. Imaging showed a BI-RADS 4 lesion on mammography and a heterogeneous, lobulated mass on computed tomography (CT), confined to the breast. Core biopsy suggested low-grade invasive carcinoma. She underwent a left simple mastectomy with sentinel lymph node biopsy. Histopathology was consistent with features of TCCRP. IHC and molecular analysis revealed a hormone receptor (HR)-positive TCCRP with IDH1 R132 mutation with low proliferative index. The patient received adjuvant radiotherapy (40 Gy/15 fractions) and is under 5-year letrozole therapy. At 18-month follow-up, she remained disease-free, with no recurrence or metastasis. This case underscores the clinical, histopathological, immunophenotypic, and molecular features of TCCRP, including the rare IDH1 R132H mutation. Timely surgical and hormonal therapy ensures excellent prognosis, and future studies on targeted IDH1/IDH2 and PIK3CA therapies may expand treatment options.

Metastasis of renal cell carcinoma (RCC) most frequently occurs in the lungs, bones, liver, and brain. Breast metastasis from RCC is exceedingly rare, particularly in male patients presenting with a breast mass as the initial manifestation. We report a 54-year-old man who presented with a breast nodule that, upon excision, was pathologically confirmed as metastatic Clear cell RCC. Abdominal computed tomography (CT) revealed a primary lesion in the left kidney. One month and nine months after laparoscopic partial nephrectomy, recurrent metastatic lesions were detected in the breast. After two subsequent excisions of the breast metastases, the patient was treated with lenvatinib in combination with tislelizumab. However, treatment was discontinued due to intractable diarrhoea. Three months after treatment cessation, follow-up CT imaging revealed widespread systemic metastases. The patient is currently maintained on sunitinib monotherapy. The total duration of follow-up was 30 months. This case, together with a review of earlier reported cases of RCC with breast metastasis, reveals the interesting observation that female patients with RCC appear to be more susceptible to "delayed" breast metastasis compared with male patients. Our analysis underscores the need for thorough evaluation of breast nodules in patients with an RCC history, even absent classic signs like nipple retraction or discharge. These findings may contribute to the future development of effective management guidelines for breast metastases from RCC and help clinicians better recognize this clinical entity.

Breast discharge represents the third most common reason women seek medical attention for breast-related concerns. A triple assessment is recommended for additional screening in cases of suspected ductal illness if there is nipple discharge. This study aimed to evaluate the different clinical characteristics of ductal breast disease in relation to Triple Assessment (Clinical examination, Imaging, Histopathology). This cross-sectional study was conducted among 100 purposively included female patients presented with nipple discharge (ND) selected from both Outdoor and Indoor Department of Surgery, Rajshahi Medical College Hospital (RMCH), Rajshahi, Bangladesh. Data regarding clinical, biochemical and surgical profiles were recorded. Informed written consent was taken from all the patients before data collection. Data was collected from May 2019 to October 2019. In descriptive statistics, the frequency distribution was done using STATA-18. The findings of the Triple assessment were categorized as malignant and non-malignant using the chi-squared test. All statistical tests were two-tailed. A p-value of 0.05 or less than 0.05 was considered statistically significant. Age 40 years or above (p<0.001), presence of a breast lump (p<0.001), micro-calcification found in mammography (p<0.001) and suspected malignancy in ultrasonography (p<0.001), bloody nipple discharge (p<0.001) were found statistically significant in association with malignancy compared to benign lesions. Triple assessment can help to assess high-risk patients, requiring careful treatment to rule out malignancy. Patients aged 40 years or more with the presence of breast lump and bloody discharge are at high risk of cancer. The risk of underlying cancer can be precisely established by applying the methodical, gold standard approach of Triple Assessment.

Background/Objectives: We investigated the feasibility of ductoscopy in diagnosis and management of patients presenting with clinically pathological nipple discharge (PND). Methods: Mammary ductoscopy was performed on 57 breasts with PND in 54 patients for diagnostic and therapeutic purposes. Ductoscopic abnormalities included ductal irregularities, presence of erythematous patches, or presence of intraductal papillomas, whereas duct ectasia or presence of dense fluid was considered a benign finding. Results: Age older than 40 and any pathology in ultrasound or ductoscopy were significantly associated with a decision of surgery. Surgical procedures included central duct excisions (n = 16) or specific duct excisions (n = 14) guided by either ultrasound (USG) or ductoscopy. Presence of an abnormal finding on ductoscopy was significantly associated with a specific lesion yield for PND in 18 patients, such as ductal carcinoma in situ with/without papillary cancer (n = 2, 11.1%), or intraductal papilloma/papillomatosis (n = 15, 83.3%) or periductal mastitis (n = 1, 5.6%) (specific lesion for PND; ductoscopic abnormality: 83.3% (15/18) vs. ductoscopic benign findings: 16.7% (2/12); p = 0.001) in patients undergoing surgical intervention. However, pathological findings in other imaging modalities including USG, magnetic resonance imaging (MRI) or mammogram were not associated with specific lesion yield for PND. The cancer detection rate in surgically excised lesions (n = 30) was 6.7% (n = 2). Overall, nipple discharge ceased in three patients who were conservatively observed after benign findings on ductoscopy at a median of 58 months (IQR, 39-77). Conclusions: The use of ductoscopy facilitated surgical decision-making in patients with PND, helping to distinguish patients requiring surgical excision from those suitable for conservative follow-up. In this cohort, ductoscopy findings were frequently associated with specific lesions, including mostly intraductal papilloma, explaining nipple discharge in patients selected for surgery.

Apocrine carcinoma (AC) of the breast is a rare histological subtype, classically characterized by androgen receptor (AR) positivity with estrogen receptor (ER) and progesterone receptor (PR) negativity. We report the case of a 35-year-old premenopausal woman who presented with a five-month history of a left retroareolar breast lump associated with intermittent serous nipple discharge. Clinical examination and breast imaging revealed a suspicious lesion, and core needle biopsy suggested invasive ductal carcinoma. The patient underwent nipple-sparing breast conservation surgery with axillary clearance. Histopathological examination demonstrated invasive AC, modified Bloom-Richardson grade 1, without lymphovascular invasion or nodal metastasis. Immunohistochemistry revealed an unusual triple hormone receptor-positive profile (ER-positive, PR-positive, AR-positive), with human epidermal growth factor receptor 2 (HER2) negativity and a low Ki-67 proliferative index. Adjuvant treatment included combination chemotherapy, radiotherapy, and dual hormonal therapy with tamoxifen and an AR inhibitor. This case highlights the diagnostic and therapeutic challenges of hormone receptor-positive AC and underscores the importance of comprehensive immunohistochemical profiling for individualized management.