Paget disease of the breast

A 50-year-old woman comes to the clinic following an abnormal mammogram showing calcifications in the right breast. Medical history is remarkable for type 2 diabetes mellitus managed with metformin. She does not smoke or use alcohol excessively, and she has not experienced weight loss, fever, or trauma. She is referred for a biopsy, which confirms the diagnosis of benign fat necrosis. However, during the biopsy, another area suspected of malignancy is found. The results of the biopsy of this additional are are shown below:  



Reproduced from: flickr

This type of cancer is associated with which of the following?