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a. Ductal carcinoma in situ 7. A 35-year-old woman consults her family physician because
b. Intraductal papilloma of painful swelling of her breasts, particularly as she
c. Lobular carcinoma in situ approaches the end of her menstrual cycle. On self-
d. Medullary carcinoma examination she recently felt a tender nodule in the right
e. Paget disease breast. Physical examination reveals an irregular nodularity
of both breasts with diffuse tenderness. Examination of the
4. A 53-year-old woman discovers a lump in her breast and axilla is negative. A mammogram demonstrates irregular
physical examination confirms a mass in the lower, outer areas of density in the lower, outer quadrants of both
quadrant of the left breast. Mammography demonstrates an breasts. Which of the following histopathologic features is
ill-defined, stellate density measuring 1 cm. Needle considered to be a risk factor for the development of
aspiration reveals malignant ductal epithelial cells. A carcinoma in this patient?
modified radical mastectomy is performed. The surgical a. Apocrine metaplasia
specimen reveals a firm irregular mass (arrows). Which of b. Cystic change
the following cellular markers would be the most useful to c. Duct ectasia
evaluate before considering therapeutic options for this d. Papillomatosis
patient? e. Stromal fibrosis
a. Gene amplification
b. Insertional mutagenesis
c. Chromosomal nonhomologous crossing over
d. Polyploidy
e. Single nucleotide polymorphism
a. Colloid carcinoma
17. A 45-year-old woman discovers a solitary, freely movable b. Lobular carcinoma in situ
mass in her right breast on self-examination, which is c. Malignant phyllodes tumor
confirmed on physical examination. Mammography d. Medullary carcinoma
demonstrates focal calcification, with a linear configuration e. Tubular carcinoma
in the region of the breast mass. A breast biopsy (shown
in the image) reveals large, pleomorphic epithelial cells 20. A 22-year-old woman nursing her newborn develops
confined to dilated ducts, with central zones of necrosis. a tender erythematous area around the nipple of her left
What is the appropriate pathologic diagnosis? breast. On physical examination, a purulent exudate is
observed to drain from an open fissure. Culture of this
exudate will most likely grow which of the following
microorganisms?
a. Candida albicans
b. Escherichia coli
c. Haemophilus influenza
d. Lactobacillus acidophilus
e. Staphylococcus aureus
ANSWERS
1. B. Fat necrosis
A history of trauma can usually be elicited in cases of fat
necrosis occurring in the breast. Initially, the lesion consists
of necrosis of adipocytes and hemorrhage, after which
phagocytic cells remove the lipid debris. Fibroblastic
proliferation during healing leads to fingers of fibrous scar
tissue that extend into the adjacent breast tissue. As a result,
an irregular, fixed, hard mass may ensue and clinically
resemble breast cancer. Dystrophic calcification, a common
feature of breast cancer, may also be detected
a. Invasive ductal carcinoma
radiographically in areas of fat necrosis. Thus, the lesions
b. Invasive lobular carcinoma
often require biopsy to establish their benign character. The
c. Medullary carcinoma
other choices are not associated with trauma.
d. Paget disease
Diagnosis: Fat necrosis of the breast
e. Phyllodes tumor
2. B. Desmoplasia
23. A 45-year-old woman presents with an oozing, reddish
Breast cancer is the most common malignancy of women in
patch on her left nipple (patient shown in the image). The
the United States, and the mortality from this disease among
patient has a history of skin rashes and food allergies and
women is second only to that of lung cancer. Invasive, or
believes this condition is due to an allergic reaction to her
infiltrating, ductal carcinoma is the most common form of
bra. Cytologic examination of fluid oozing from the skin
breast cancer. In this cancer stromal invasion by malignant
lesion reveals neoplastic cells. Excisional biopsy shows
cells usually incites a pronounced fibroblastic proliferation.
large clear malignant cells in the epidermis of the areola.
This “desmoplasia” creates a palpable mass, which is the
Which of the following is the most likely diagnosis?
most common initial sign of ductal carcinoma. Invasive
ductal carcinoma usually manifests as a hard, fixed mass,
which is often referred to as scirrhous carcinoma. On gross
examination, the tumor is typically firm and shows irregular
margins. The cut surface is pale gray and gritty and flecked
with yellow, chalky streaks. Microscopically, invasive ductal
carcinoma grows as irregular nests and cords of epithelial
cells, usually within a dense fibrous stroma. Metaplasia
(choice E) is the conversion of one differentiated cell type to
another. Lipohyalinosis (choice D) is a particular form of
fibrosis associated with fat deposition. Fibrinolysis (choice C)
is related to clot dissolution.
Diagnosis: Invasive ductal carcinoma of the breast
3. B. Intraductal papilloma
a. Chronic dermatitis Intraductal papilloma is a benign breast tumor that usually
b. Colloid carcinoma causes nipple discharge (serous or hemorrhagic) and occurs
c. Intraductal papilloma in the lactiferous ducts of middle-aged and older women.
d. Paget disease Because intraductal papilloma is situated in the large,
e. Phyllodes tumor subareolar ducts, the lesion may be associated with a
serous or bloody nipple discharge. This lesion must be
24. A 60-year-old woman presents with a large breast mass distinguished from papillomatosis, which occurs in the
that she first detected 3 months ago. Mammography peripheral ducts as a component of proliferative fibrocystic
reveals a well-circumscribed mass measuring 8 cm in change. Intraductal papillomas are attached to the wall of the
diameter. A breast biopsy shows loose fibroconnective duct by a fibrovascular stalk. The papillomatous portion
tissue with a sarcomatous stroma, abundant mitoses, and consists of a double layer of epithelial cells, an outer layer of
nodules and ridges lined by cuboidal epithelial cells. cuboidal or columnar cells, and an inner layer of more
Which of the following is the appropriate diagnosis? rounded myoepithelial cells. Solitary intraductal papilloma is
a. Fibroadenoma not a premalignant lesion or a marker for increased risk of
b. Medullary carcinoma cancer in the breast. Ductal carcinoma in situ (choice A) and
c. Paget disease lobular carcinoma in situ (choice C) feature neoplastic cells
d. Phyllodes tumor confined to ducts and lobules, respectively, and typically lack
e. Tubular carcinoma myoepithelial cells. Paget disease (choice E) is a form of
carcinoma that involves the epidermis of the nipple and
25. A 55-year-old man presents with a solitary breast mass areola.
and biopsy reveals malignant cells. Immunohistochemical Diagnosis: Intraductal papilloma
staining experiments show that the tumor cells are positive
for HER2/neu and cytokeratins 4 and 11 and negative for 4. B. Estrogen receptors
estrogen receptors. What is the most likely diagnosis? Over half of breast cancers exhibit nuclear estrogen receptor
a. Basal cell carcinoma protein. A slightly smaller proportion also has progesterone
b. Invasive ductal carcinoma receptors. Women whose cancers possess hormone
c. Invasive lobular carcinoma receptors have a longer disease-free survival and overall
d. Medullary carcinoma survival than those with early-stage cancers who are
e. Tubular adenoma negative for these receptors. The beneficial effects of
oophorectomy on survival in patients with breast cancer led
to the use of estrogen antagonists in the treatment of breast