51 year old female MRM specimen Sections from breast ?MBC on FNAB H/O infertility Please opine

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••Older age,Nulliparity,Obesity - Dysmetabolism,+ve Family history, BRCA1/2 mutations, IVF treated infertility cases,Extensive DCIS are risk factors for breast carcinoma. ••Indications for mastectomy are Extensive DCIS (multifocality & large),high grade DCIS lesions, failure to achieve adequate margins after lumpectomy, recurrent DCIS due to positive margins,previous radiation of the breast and/or contra-indication for radiotherapy. ••MBC/Metastatic Breast Carcinoma : Distant Metastasis are knowm with DCIS,but rare. ••MBCs/Medullary Breast Carcinomas :  Are rare variants of breast carcinoma with good prognosis. Account for less than 5% of invasive breast carcinoma. Clinically present as solitary well-circumscribed firm lump in the breast. Clinically, radiologically & on gross examination, they are often misdiagnosed as a fibroadenoma. This emphasizes the need for microscopic diagnosis.*On IHC are often triple negativity (ER, PR, Her2/neu) with grade 3 Nottinghams criteria and exhibits basal phenotype. *On Cytology exhibit cellular smears with malignant cells arranged in syncytial groups & also as many large isolated cells of high nuclear grade & prominent nucleoli.In addition lymphocytic & plasma cell infiltrates are conspicuous in the background. *On Bx,constellation of 5 histological features : •Syncitial growth pattern in atleast 75% of tumor(cell margins not distinct),•Heavy mononuclear/lymphoplasmacytic inflammatory infiltrate (CD3/CD8+ve T cells),•Microscopically circumscribed (No finger like infiltration/ invasion is by broad front),•Absence of Neoplastic ducts, glands or tubule formation & •High grade pleomorphic nuclei with prominent nucleoli. ••Sections submitted show FSO : FCD with DCIS.•• Features of Medullary carcinoma of breast ard not seen. ••Advised further grossing from suspicious areas.

Again seen the sections posted.. I stick to my previous comments. No evidence of medullary ca.. nor mets.

At best it can be labeled as.. ? DCIS.. clinging type

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