Chapter 19 - Breast: Questions

What are the most common breast changes in age 35-50 in women? A. Fibroadenoma B. Fibrocystic changes C. Intraductal carcinoma D. Invasive carcinoma E. Papilloma

B. Fibrocystic changes Fibrocystic changes are the most common breast changes in women between the ages of 35-50. Fibrocystic changes refer to a group of benign breast conditions that are characterized by lumps, cysts, and other changes in breast tissue that can cause pain, tenderness, and swelling. Fibroadenomas are also a common breast change in this age range, but they are less common than fibrocystic changes. Intraductal carcinoma, invasive carcinoma, and papilloma are all less common in this age range, but can still occur and require medical evaluation if any breast changes or symptoms occur.

8. Features common to all invasive carcinomas are EXEPT: A. Orange peel-like skin B. Retraction of the nipple desmoplasia C. A fixation to pectoral muscles D. Desmoplasia E. Dimpling of the skin

C. A fixation to pectoral muscles

25 A 26-year-old woman has felt a breast lump for the past month and is worried because she has a family history of earlyonset and bilateral breast cancers. On physical examination, there is a firm, 2-cm mass in the upper outer quadrant of her left breast. A biopsy is done, and the specimen microscopically shows carcinoma. Genetic analysis shows that she is a carrier of the BRCA1 gene mutation, as are her mother and sister. Which of the following histologic types of breast carcinoma has the highest incidence in families such as hers? □ (A) Lobular carcinoma □ (B) Tubular carcinoma □ (C) Metaplastic carcinoma □ (D) Papillary carcinoma □ (E) Medullary carcinoma

(E) Patients with the BRCA1 gene mutation have a high incidence of medullary carcinomas that are poorly differentiated, do not express the HER2/neu protein, and are negative for estrogen and progesterone receptors.

1 A 36-year-old woman has noticed a bloody discharge from the nipple of her right breast for the past 3 days. On physical examination, the skin of the breasts appears normal, and no masses are palpable. There is no axillary lymphadenopathy. The patient has regular menstrual cycles and is using oral contraceptives. Excisional biopsy is most likely to show which of the following lesions in her right breast? □ (A) Fibroadenoma □ (B) Phyllodes tumor □ (C) Acute mastitis □ (D) Intraductal papilloma □ (E) Sclerosing adenosis

1 (D) Intraductal papillomas are usually solitary and smaller than 1 cm. They are located in large lactiferous sinuses or ducts, and have a tendency to bleed. Fibroadenomas contain ducts with stroma and are not highly vascular; these lesions are not located in ducts. Phyllodes tumors also arise from intralobular stroma and can be malignant. They do not invade ducts to cause bleeding. Abscesses complicating mastitis organize with a fibrous wall. Sclerosing adenosis, a lesion occurring with fibrocystic changes, has abundant collagen, not vascularity.

18 A study of women with breast carcinoma is done to determine the presence and amount of estrogen receptor (ER) and progesterone receptor (PR) in the carcinoma cells. Large amounts of ER and PR are found in the carcinoma cells of some patients. These receptors are not present in the cells of other patients. The patients with positivity for ER-PR are likely to exhibit which of the following traits? □ (A) Higher response to therapy □ (B) Increased immunogenicity □ (C) Greater risk of familial breast cancer □ (D) Higher tumor stage □ (E) Greater likelihood of metastases □ (F) Greater aneuploidy with flow cytometry □ (G) Higher tumor grade

1 8 (A) The estrogen receptor and progesterone receptor (ER-PR) status helps predict whether chemotherapy with antiestrogen compounds such as tamoxifen would be effective; however, the correlation is not perfect. The ER and PR do not affect immunogenicity and are not targets for immunotherapy. In contrast, immunotherapy targeted to the overexpressed HER2/neu gene is being used. The overall prognosis may be predicted from several factors, including histologic type, histologic grade, presence of metastases, degree of aneuploidy, and tumor stage. A family history and the presence of specific mutations such as BRCA1 or BRCA2 correlate with familial risk of breast cancer.

19 A 50-year-old woman has a routine health examination. There are no remarkable findings on physical examination, but a mammogram shows a 1-cm, irregular density in the right breast. A fine-needle aspirate of the lesion contains malignant cells. The mass is excised, and axillary lymph node sampling is performed. The microscopic features of the neoplasm are consistent with ductal carcinoma in situ. There are no lymph node metastases. She receives radiation therapy. Which of the following statements provides the most appropriate advice to the patient? □ (A) You will probably survive less than 5 years □ (B) Another cancer is probably present in the opposite breast □ (C) Distant metastases are unlikely to be found □ (D) Your family members should be screened for BRCA1 and BRCA2 mutations □ (E) Flow cytometry can determine whether chemotherapy is warranted

1 9 (C) At least half of mammographically detected breast cancers are ductal carcinoma in situ (DCIS). This in situ carcinoma is highly unlikely to metastasize because the cells lack the ability to invade basement membrane. With surgical excision and radiotherapy, the 5-year survival rate is high, although some tumors may progress to invasive lesions over time. Lobular carcinomas are most likely to be present in the opposite breast. Patients with BRCA1 or BRCA2 mutations can have familial breast carcinomas. In these patients, there is usually a strong family history, and the age of onset may be early. The occurrence of a sporadic breast cancer in a racial group that is not at high risk of familial cancer does not warrant mutational analysis of BRCA1 and BRCA2. Flow cytometry is useful to suggest prognosis, not treatment.

10 A 44-year-old woman noticed a lump in her right breast. On examination, she has an ill-defined, 1-cm mass in the upper outer quadrant. The mass is cystic on ultrasound. An excision is done, and the mass shows predominantly fibrocystic changes, but carcinoma also is present. Fine-needle aspirates of both breasts reveal additional foci of similar malignant cells. Which of the following breast carcinomas is most likely to produce these findings? □ (A) Ductal carcinoma □ (B) Lobular carcinoma □ (C) Malignant phyllodes tumor □ (D) Medullary carcinoma □ (E) Mucinous (colloid) carcinoma

10 (B) Among primary malignancies of the breast, lobular carcinoma in situ (LCIS) is most likely to be bilateral. LCIS may precede invasive lesions by several years. Lobular carcinoma may be mixed with ductal carcinoma, and it may be difficult to distinguish them histologically. The other neoplasms listed are less likely to be bilateral and more likely to produce a mass effect.

11 A 56-year-old woman sees her physician for a routine health examination. There are no remarkable findings on physical examination. A mammogram shows a 0.5-cm irregular area of increased density with scattered microcalcifications in the upper outer quadrant of the left breast. Excisional biopsy shows atypical lobular hyperplasia. The patient has been on postmenopausal estrogen-progesterone therapy for the past 10 years. She has smoked 1 pack of cigarettes per day for the past 35 years. Which of the following conclusions is most pertinent to these findings? □ (A) She has the BRCA1 gene mutation □ (B) The postmenopausal estrogen replacement therapy should be stopped □ (C) Her risk of breast carcinoma is increased □ (D) She should undergo bilateral simple mastectomies □ (E) She should stop smoking

11 (C) Atypical lobular hyperplasia and atypical ductal hyperplasia increase the risk of breast cancer fivefold; the risk affects both breasts and is higher in premenopausal women or women who have a family history of breast cancer. The BRCA1 mutation accounts for about 10% to 20% of familial breast carcinomas and only a few percent of all breast cancers. Mastectomies are probably not warranted at this time, but close follow-up is needed. Smoking and exogenous estrogen therapy are not well-established risk factors for breast cancer.

13 A 55-year-old woman has felt a poorly defined lump in her right breast for the past year. On examination, she has a nontender, firm, 6-cm mass in the upper inner quadrant. There are no lesions of the overlying skin and no axillary lymphadenopathy. Needle biopsy is done, and microscopic examination of the specimen shows cellular stroma protruding into spaces lined by a single-layer cuboidal epithelium. The mass is excised with a wide margin, but recurs 1 year later. After further excision, the lesion does not recur. What is the most likely diagnosis? □ (A) Fibroadenoma □ (B) Fibrocystic changes □ (C) Lobular carcinoma □ (D) Phyllodes tumor □ (E) Tubular carcinoma

13 (D) Phyllodes tumors, although grossly and microscopically similar to fibroadenomas, occur at an older age, are larger, and are more cellular; they can recur locally, but rarely metastasize. Fibrocystic changes can produce a breast lump, but usually not as large as 6 cm, and without firm areas of cellular stroma. A lobular carcinoma has malignant-appearing epithelial cells in clusters and rows and may not even produce a mass effect. Tubular carcinomas of the breast are uncommon, most are less than 1 cm in diameter, and most have small tubular structures in a noncellular stroma

14 A 51-year-old woman has noticed an area of swelling with tenderness in her right breast that has worsened over the past 2 months. On physical examination, the 7-cm area of erythematous skin is tender and firm. There is swelling of the right breast, nipple retraction, and right axillary lymphadenopathy. Excisional biopsy is most likely to show which of the following lesions? □ (A) Atypical epithelial hyperplasia □ (B) Phyllodes tumor □ (C) Fat necrosis □ (D) Sclerosing adenosis □ (E) Infiltrating ductal carcinoma

14 (E) The gross appearance of the skin is consistent with invasion of dermal lymphatics by carcinoma—the so-called inflammatory carcinoma. Nipple retraction and axillary lymphadenopathy also suggest invasive ductal carcinoma. Atypical ductal hyperplasia may increase the risk of carcinoma, but it does not produce visible surface skin changes. A phyllodes tumor can be large and sometimes tender, but the overlying skin is typically not affected, and spread to lymph nodes is uncommon. The feel of fat necrosis on palpation can mimic that of carcinoma, but the skin is not involved. Sclerosing adenosis is a feature of benign fibrocystic changes and has no skin involvement.

15 A 39-year-old woman has noticed an enlarging mass in her left breast for the past 2 years. The physician palpates a 4- cm firm mass. A simple mastectomy is performed with axillary lymph node sampling and plastic reconstruction of the breast. On gross sectioning, the mass has a soft, tan, fleshy surface. Histologically, the mass is composed of large cells with vesicular nuclei and prominent nucleoli. There is a marked lymphocytic infiltrate within the tumor, and the tumor has a discrete, noninfiltrative border. No axillary node metastases are present. The tumor cells are negative for estrogen receptor and progesterone receptor. What is the most likely diagnosis? □ (A) Colloid carcinoma □ (B) Fibroadenoma □ (C) Infiltrating ductal carcinoma □ (D) Infiltrating lobular carcinoma □ (E) Intraductal papilloma □ (F) Medullary carcinoma □ (G) Papillary carcinoma □ (H) Phyllodes tumor

15 (F) Medullary carcinomas account for about 1% to 5% of all breast carcinomas. They tend to occur in women at younger ages than do most other breast cancers. Despite poor prognostic indicators, such as absence of estrogen receptors and progesterone receptors (ER-PR), medullary carcinomas have a better prognosis than most other breast cancers. Perhaps the infiltrating lymphocytes are helpful. Colloid carcinomas occur about as frequently as medullary carcinomas, but they are often positive for ER-PR, and the prognosis is better than average. Fibroadenomas are small benign lesions that tend to stop enlarging after menopause, when hormonal stimulation has ceased. Infiltrating ductal and infiltrating lobular carcinomas tend not to produce large, localized lesions because they are more invasive, and they lack a distinct lymphoid infiltrate. Intraductal papillomas are unlikely to be larger than 1 cm. True papillary carcinomas are quite rare, although other types of breast carcinoma may have a papillary component. The phyllodes tumor is typically large, but it has stromal and glandular components.

16 A 47-year-old woman has a routine health examination. There are no remarkable findings except for a barely palpable mass in the right breast. A mammogram shows an irregular, 1.5-cm area of density in the upper outer quadrant. Scattered microcalcifications are present in the density. A biopsy specimen from this area shows atypical ductal hyperplasia. Which of the following is the most appropriate advice to give to this patient? □ (A) There is a risk of cancer in the opposite breast □ (B) A mastectomy should be performed □ (C) These changes are related to smoking cigarettes □ (D) Antibiotic therapy is indicated to treat the lesion □ (E) The BRCA1 oncogene has been inherited

16 (A) Fibrocystic changes without epithelial hyperplasia do not suggest an increased risk of breast cancer. Moderate to florid hyperplasia increases the risk twofold, and atypical ductal or lobular hyperplasias increase the risk fivefold. The risk in this patient is not great enough to suggest radical or simple mastectomy at this time. Breast cancers are not associated with tobacco use. These changes are not the result of infection. The BRCA1 gene accounts for a small percentage of breast cancers, primarily in families in which cancer onset occurs at a young age.

2 A 28-year-old woman in the third trimester of her third pregnancy discovered a lump in her left breast. The physician palpated a 2-cm, discrete, freely movable mass beneath the nipple. After the birth of a term infant, the mass appears to decrease slightly in size. The infant breastfeeds without difficulty. What is the most likely diagnosis? □ (A) Intraductal papilloma □ (B) Phyllodes tumor □ (C) Lobular carcinoma in situ □ (D) Fibroadenoma □ (E) Medullary carcinoma

2 (D) Fibroadenomas are common and may enlarge during pregnancy or late in each menstrual cycle. Most intraductal papillomas are smaller than 1 cm and are not influenced by hormonal changes. Phyllodes tumors are uncommon and tend to be larger than 4 cm. Lobular carcinoma in situ is typically an ill-defined lesion without a mass effect. Medullary carcinomas tend to be large; they account for only about 1% of all breast carcinomas.

A 29-year-old woman and her 32-year-old sister were diagnosed with infiltrating ductal carcinoma of the breast, and both had bilateral mastectomies. Which of the following risk factors is most significant for this type of cancer? □ (A) Oral contraceptive use □ (B) Inheritance of a mutant p53 allele □ (C) Obesity □ (D) Multiparity □ (E) Smoking cigarettes

2 1 (B) Bilateral breast cancer in very young women in the same family suggests a germline mutation in a tumorsuppressor gene. The affected genes may be BRCA1, BRCA2, or p53. The BRCA1 and BRCA2 genes account for most hereditary breast cancers. Establishment of other risk factors is not as secure. Multiparity reduces the risk of breast cancer.

22 A 63-year-old woman feels a small lump in her right breast. The physician palpates a firm area that has a cordlike feel. No lesions of the overlying skin are present, and there is no axillary lymphadenopathy. A mammogram shows a density that contains microcalcifications. An excisional biopsy specimen contains soft, white material that is extruded from small ducts when pressure is applied. Microscopic examination shows ducts that contain large, atypical cells in a cribriform pattern. What is the most likely diagnosis? □ (A) Colloid carcinoma □ (B) Infiltrating ductal carcinoma □ (C) Infiltrating lobular carcinoma □ (D) Comedocarcinoma □ (E) Medullary carcinoma □ (F) Paget disease of the breast □ (G) Papillary carcinoma □ (H) Phyllodes tumor

22 (D) Comedo carcinoma, also known as comedocarcinoma, is a subtype of ductal carcinoma in situ (DCIS), which is a type of breast cancer. Comedo carcinoma is considered a high-grade subtype of DCIS because it has a tendency to grow more quickly and has a higher potential for developing into invasive breast cancer. Comedo carcinoma is characterized by the presence of central necrosis within the tumor mass. The necrotic material is visible as a white, cheesy material that can be expressed from the breast duct on examination. The necrosis is caused by the rapid growth of the cancer cells, which outstrips the ability of the surrounding blood vessels to supply nutrients and oxygen to the tumor. Comedo carcinoma is typically detected on mammography as microcalcifications that have a characteristic "popcorn" appearance due to the presence of the necrotic material. These microcalcifications are usually clustered together, indicating a high likelihood of malignancy. Colloid carcinomas occur about as frequently as medullary carcinomas, but they are often positive for estrogen receptor and progesterone receptor, and the prognosis is better than average. Infiltrating ductal carcinomas tend to produce irregular, firm, mass lesions because they are more invasive. Infiltrating lobular carcinomas can have a diffuse pattern without significant mass effect. Medullary carcinomas tend to be large masses; microscopically, they have nests of large cells with a surrounding lymphoid infiltrate. True papillary carcinomas are rare, although a papillary component may be present in other types of breast carcinoma. The phyllodes tumor is typically large, but it has stromal and glandular components.

23 An epidemiologic study is conducted with male subjects who have been diagnosed with breast carcinoma. Their demographic data, past medical histories, family histories, and laboratory data are examined to identify factors that increase the risk of cancer. Which of the following factors is most likely to increase significantly the risk of developing male breast carcinoma? □ (A) Gynecomastia □ (B) Age older than 70 years □ (C) Asian ancestry □ (D) Chronic alcoholism □ (E) BRCA1 gene mutation

23 (B) Male breast cancers are rare, and they occur primarily among the elderly. Additional risk factors include firstdegree relatives with breast cancer, decreased testicular function, exposure to exogenous estrogens, infertility, obesity, prior benign breast disease, exposure to ionizing radiation, and residency in Western countries. Gynecomastia does not seem to be a risk factor. Of cases in men, 4% to 14% are attributed to germline BRCA2 mutations.

24 A clinical study is performed on postmenopausal women living in Tampa, Florida, who are between the ages of 45 and 70 years. All have been diagnosed with infiltrating ductal carcinoma positive for estrogen receptor (ER) and progesterone receptor (PR), which has been confirmed by biopsy and microscopic examination of tissue. None has the BRCA1 or BRCA2 mutation. Which of the following is most likely to indicate the highest relative risk of developing the carcinomas seen in this group of women? □ (A) Age at menarche older than 16 years □ (B) Age at menopause younger than 45 years □ (C) First-degree relative with breast cancer □ (D) Smoking cigarettes (>40 pack-years) □ (E) Multiparity □ (F) Prior diagnosis of mastitis

24 (C) The relative risk of breast cancer increases with various factors, but family history is one of the strongest. A history of bilateral breast disease and earlier age of onset of cancer increase the risk. The earlier age of onset increases the riskof BRCA1 or BRCA2. A longer reproductive life, with early menarche (<11 years old) and late menopause (>55 years old), and nulliparity increase the risk of breast cancer, probably because of increased estrogen exposure. "Soft" risk factorsinclude exogenous estrogens, obesity, and smoking. Mastitis does not affect the risk of breast cancer.

3 A 30-year-old woman sustained a traumatic blow to her right breast. Initially, there was a 3-cm contusion that resolved within 3 weeks, but she then felt a firm lump that persisted below the site of the bruise 1 month later. What is the most likely diagnosis for this lump? □ (A) Fibroadenoma □ (B) Sclerosing adenosis □ (C) Fat necrosis □ (D) Ductal carcinoma in situ □ (E) Mammary duct ectasia

3 (C) Fat necrosis is typically caused by trauma to the breast. The damaged, necrotic fat is phagocytosed by macrophages, which become lipid laden. The lesion resolves as a collagenous scar within weeks to months. The firm scar can mammographically and grossly resemble a carcinoma, however. A fibroadenoma is a neoplasm, and tumors are not induced by trauma. Sclerosing adenosis is a feature of fibrocystic changes, a common cause of nontraumatic breast lumps. An intraductal carcinoma may not form a palpable mass lesion. Mammary duct ectasia from inspissated secretions can induce chronic inflammation and fibrosis, which mimic a carcinoma.

4 A 55-year-old man has developed bilateral breast enlargement over the past year. On physical examination, the enlargement is symmetric and is not painful to palpation. There are no masses. The patient is not obese and is not taking any medications. Which of the following underlying conditions best accounts for these findings? □ (A) Micronodular cirrhosis □ (B) Chronic glomerulonephritis □ (C) Choriocarcinoma of the testis □ (D) ACTH-secreting pituitary adenoma □ (E) Rheumatoid arthritis

4 (A) Micronodular cirrhosis is most often a consequence of chronic alcoholism and impairs hepatic estrogen metabolism, which can lead to gynecomastia. Chronic renal failure is unlikely to have this consequence. Choriocarcinomas of the testis produce human chorionic gonadotropin, not estrogens. ACTH-secreting pituitary adenomas cause truncal obesity because of Cushing syndrome. Rheumatoid nodules can appear in various locations along with rheumatoid arthritis, but they rarely occur in the breast and are unlikely to be bilateral.

8 Three weeks after giving birth to a normal term infant, a 24-year-old woman is breastfeeding the infant and notices fissures in the skin around her left nipple. Over the next 3 days, the region around the nipple becomes erythematous and tender. Purulent exudate from a small abscess drains through a fissure. Which of the following organisms is most likely to be cultured from the exudate? □ (A) Listeria monocytogenes □ (B) Streptococcus viridans □ (C) Candida albicans □ (D) Staphylococcus aureus □ (E) Lactobacillus acidophilus

8 (D) Staphylococcal acute mastitis typically produces localized abscesses, whereas streptococcal infections tend to spread throughout the breast. Listeriosis can be spread by contaminated food, including milk products, not by human milk. Candida may cause some local skin irritation, but is likely to become invasive only in immunosuppressed patients. Lactobacillus acidophilus is the organism used to produce fermented nonhuman milk.

9 A 27-year-old woman feels a lump in her right breast. She has normal menstrual cycles, she is G3, P3, and her last child was born 5 years ago. The physician palpates a 2-cm, irregular, firm area beneath the lateral edge of the areola. The mass is not painful and does not feel firm. There are no lesions of the overlying skin and no axillary lymphadenopathy. A biopsy specimen shows microscopic evidence of an increased number of ducts, which are compressed because of proliferation of fibrous connective tissue. Dilated ducts with apocrine metaplasia also are present. What is the most likely diagnosis? □ (A) Traumatic fat necrosis □ (B) Fibrocystic changes □ (C) Mammary duct ectasia □ (D) Fibroadenoma □ (E) Infiltrating ductal carcinoma

9 (B) Fibrocystic changes account for the largest category of breast lumps, statistically about 40% of all breast "lumps." These lesions are probably related to cyclic breast changes that occur during the menstrual cycle. In about 30% of cases of breast lumps, no specific pathologic diagnosis can be made. Fibrocystic changes include ductal proliferation, ductal dilation (sometimes with apocrine metaplasia), and fibrosis. Fat necrosis may produce a localized, firm lesion that mimics carcinoma, but histology shows macrophages and neutrophils surrounding necrotic adipocytes, and healing leaves a fibrous scar. Inspissated duct secretions may produce duct ectasia with a surrounding lymphoplasmacytic infiltrate. A fibroadenoma is a discrete mass formed by a proliferation of fibrous stroma with compressed ductules. Carcinomas have proliferations of atypical neoplastic cells that fill ducts and can invade stroma.

A 45-year-old woman presents with a palpable lump in her left breast. Imaging reveals a 3cm mass with indistinct borders. Fine needle aspiration cytology reveals cellular pleomorphism, prominent nucleoli, and a high mitotic rate. What is the most likely diagnosis? A) Invasive ductal carcinoma B) Intraductal papilloma C) Fibroadenoma D) Mastitis

A) Invasive ductal carcinoma. The clinical presentation and imaging findings are suggestive of a breast malignancy. The cytologic features of cellular pleomorphism, prominent nucleoli, and a high mitotic rate are consistent with the diagnosis of invasive ductal carcinoma. According to Robbins pathology book, "Invasive ductal carcinoma accounts for approximately 70-80% of all breast carcinomas and is the most common type of breast carcinoma."

What is the most common type of noninvasive breast cancer? A. Ductal carcinoma in situ (DCIS) B. Lobular carcinoma in situ (LCIS) C. Paget disease of the nipple D. Intraductal papilloma

A. Ductal carcinoma in situ (DCIS) is the most common type of noninvasive breast cancer. "DCIS is the most common form of noninvasive breast cancer, accounting for about 20% of all breast cancers"

Luminal A molecular subtype of breast cancer is characterized by: A. ER positivity, HER2/NEU negativity B. ER positivity, HER2/NEU overexpression C. ER negativity, HER2/NEU negativity D. A+B E. A+B+C

A. ER positivity, HER2/NEU negativity

A 8 cm circumscribed mass of the right breast is biopsied in a 26-year-old woman. Microscopically, the lesion showed loose fibroblastic stroma containing compressed ducts lined by lining. This lesion is most likely: A. Fibroadenoma B. Sclerosing adenosis C. Medullary carcinoma D. Phyllodes tumor E. Fibrocystic change

A. Fibroadenoma

Which of the following pathological changes most strongly suggests an increased risk for carcinoma of the breast in a 45-year-old woman? A. Lobular epithelial hyperplasia B. Sclerosing adenosis C. Fat necrosis D. Plasma cell mastitis E. Multiple cysts lined by epithelium showing apocrine metaplasia

A. Lobular epithelial hyperplasia

What type of breast cancer is considered a marker of increased risk for invasive breast cancer: A. Paget disease B. Intracystis papillary cancer C. ALCIS D. DCIS E. Intracystic papilloma

A. Paget disease\D. DCIS Ductal carcinoma in situ (DCIS) is considered a marker of increased risk for invasive breast cancer. DCIS is a non-invasive type of breast cancer where abnormal cells are found in the lining of the milk ducts of the breast. If left untreated, it can develop into invasive breast cancer over time. Women with DCIS are at a higher risk of developing invasive breast cancer in the same breast, as well as in the opposite breast. Paget's disease, intraductal papillary cancer, intracystic papilloma, and atypical lobular hyperplasia (ALH) are other types of breast conditions that can increase a woman's risk of developing breast cancer, but they are not as strongly associated with an increased risk as DCIS.

Which of the following is a characteristic feature of invasive ductal carcinoma? A. Pleomorphic nuclei B. Eccentric nuclei C. Multinucleated cells D. Rosette-like structures

A. Pleomorphic nuclei are a characteristic feature of invasive ductal carcinoma. "Invasive ductal carcinomas are characterized by pleomorphic nuclei with large nucleoli, often arranged in cords, nests, or sheets"

Sclerosing adenosis is characterized by: A. Stromal fibrosis B. Apocrine metaplasia C. Inflammation D. Siderophages E. Pain

A. Stromal fibrosis Sclerosing adenosis is a benign breast condition characterized by an overgrowth of glandular tissue and stromal fibrosis, which can cause thickening and firmness in the breast tissue. It is not typically associated with apocrine metaplasia, inflammation, siderophages, or pain. However, some women with sclerosing adenosis may experience breast pain or discomfort.

What is the most common type of invasive breast cancer in women? A. Invasive ductal carcinoma B. Invasive lobular carcinoma C. Mucinous carcinoma D. Inflammatory breast cancer

Answer: A. Invasive ductal carcinoma is the most common type of breast cancer in women. "Invasive ductal carcinoma represents about 80% of invasive carcinomas of the breast and is the most common form of breast cancer" (Robbins Pathology, 10th edition, Chapter 19, page 1071).

What is the most common location for breast cancer? A. Upper outer quadrant B. Upper inner quadrant C. Lower outer quadrant D. Lower inner quadrant

Answer: A. The upper outer quadrant is the most common location for breast cancer. "Breast cancer occurs most commonly in the upper outer quadrant of the breast" (Robbins Pathology, 10th edition, Chapter 19, page 759).

Which of the following is a common risk factor for breast cancer? A. Age B. Family history C. Hormonal factors D. All of the above

Answer: D. All of the above are common risk factors for breast cancer. "Risk factors for breast cancer include age, family history, hormonal factors, and lifestyle factors such as diet and exercise" (Robbins Pathology, 10th edition, Chapter 19, page 759).

What is the most common benign breast tumor? A) Intraductal papilloma B) Fibroadenoma C) Phyllodes tumor D) Adenomyoepithelioma

B) Fibroadenoma. Fibroadenomas are the most common benign breast tumors, accounting for approximately 50% of all breast biopsies. Intraductal papillomas, phyllodes tumors, and adenomyoepitheliomas are all less common benign breast tumors.

A 65-year-old woman presents with a breast mass. Imaging reveals a 2.5cm mass with microcalcifications. Core biopsy reveals atypical ductal hyperplasia. What is the most appropriate management? A) Observation B) Surgical excision with clear margins C) Chemotherapy D) Radiation therapy

B) Surgical excision with clear margins. Atypical ductal hyperplasia is a high-risk lesion that increases the risk of developing breast cancer. According to Robbins pathology book, "The risk of developing breast carcinoma within 10 years is approximately 4-5 times greater than in women without ADH." Surgical excision with clear margins is recommended to reduce the risk of progression to carcinoma.

Which of the statements about breast carcinoma is TRUE? A. The most common location of breast tumors is the medial inner quadrant B. Carcinomas located in the upper outer quadrant typically spread to axillary lymph nodes C. Histologic grade has no influence on prognosis D. The presence of hormone receptors on carcinoma cells has no influence on prognosis E. All the statements are true

B. Carcinomas located in the upper outer quadrant typically spread to axillary lymph nodes

Proliferative type of fibrocystic change: A. Can be grossly distinguished from nonproliferative change B. Ductal epithelium shows histologically more than two layers of cells C. Does not contain cysts D. Is not the same as ductal carcinoma in situ (DCIS) E. All are correct

B. Ductal epithelium shows histologically more than two layers of cells B. Ductal epithelium shows histologically more than two layers of cells. Proliferative type of fibrocystic change is characterized by an increased number of cells in the ductal epithelium, which may form papillary projections into the lumen of the ducts. This change can be distinguished histologically from nonproliferative change. The term "fibrocystic change" encompasses a range of benign breast changes, including cysts, fibrosis, and proliferation of the ductal and lobular epithelium. Proliferative changes increase the risk of breast cancer, especially when combined with atypia (ADH or ALH), but they are not the same as DCIS.

2. A women who presents with a bloody nipple discharges is most likely to have: A.. Paget's disease B. Intraductal papilloma C. Invasive ductal carcinoma D. Medullary carcinoma E. Mucinous carcinoma

B. Intraductal papilloma An intraductal papilloma is a benign tumor that grows in the milk ducts of the breast, and can cause a bloody or clear nipple discharge. Paget's disease is a rare form of breast cancer that can cause changes to the skin of the nipple and areola, including redness, scaling, and itching, but it may or may not be associated with a nipple discharge. Invasive ductal carcinoma, medullary carcinoma, and mucinous carcinoma are all forms of breast cancer that can present with a bloody nipple discharge, but they are less common than benign causes such as intraductal papilloma. However, it's important for any woman with a nipple discharge to see her healthcare provider for further evaluation and diagnosis.

Proliferative lesions can be: A. Unifocal B. Multifocal C. Only in the left quadrant D. Only retromammary E. Only in the upper quadrants

B. Multifocal

Which of the following is a benign breast lesion that is associated with an increased risk of breast cancer? A. Fibroadenoma B. Sclerosing adenosis C. Intraductal papilloma D. Fat necrosis

B. Sclerosing adenosis is a benign breast lesion that is associated with an increased risk of breast cancer. "Sclerosing adenosis is a benign proliferative lesion that is associated with an increased risk of breast cancer"

A 22-year-old woman presents with a breast lump that is mobile and well-circumscribed. Imaging reveals a 2cm mass with circumscribed margins. Fine needle aspiration cytology reveals clusters of benign-appearing ductal cells. What is the most likely diagnosis? A) Invasive ductal carcinoma B) Intraductal papilloma C) Fibroadenoma D) Mastitis

C) Fibroadenoma. The clinical presentation and imaging findings are suggestive of a benign breast mass. The cytologic features of benign-appearing ductal cells support the diagnosis of a fibroadenoma. According to Robbins pathology book, "Fibroadenomas are the most common benign breast tumors, occurring primarily in women younger than 30 years."

Which of the following types of breast cancer is characterized by a "sheets of large anaplastic cells associated with pronounced lymphocytic infiltrates composed predominantly of T cells" appearance on histology? A) Invasive ductal carcinoma B) Invasive lobular carcinoma C) Invasive carcinomas with medullary features D) Paget disease of the nipple

C) Invasive carcinomas with medullary features Carcinomas with medullary features are a special type of triple-negative cancer comprising about 5% of all breast cancers. These carcinomas typically grow as rounded masses that can be difficult to distinguish from benign tumors on imaging. They consist of sheets of large anaplastic cells associated with pronounced lymphocytic infiltrates composed predominantly of T cells

Which of the following is the most common type of breast carcinoma: A. Intraductal B. Mucinous C. Ductal invasive, no special type D. Inflammatory E. Lobular invasive

C. Ductal invasive, no special type Ductal invasive, no special type is the most common type of breast carcinoma, accounting for about 70-80% of all cases. Intraductal carcinoma is also common, but it is not invasive and is confined to the milk ducts. Lobular invasive carcinoma, mucinous carcinoma, and inflammatory breast carcinoma are less common.

A 25-year-old man goes to the gym every day and wants to increase his muscle mass by using anabolic steroids. Which change can develop in his breasts as a consequence of that? A. Fibrosis B. Breast carcinoma C. Gynecomastia D. Sclerosing adenosis

C. Gynecomastia

Which of the following types of breast cancer is most commonly associated with BRCA1 mutations? A) Invasive ductal carcinoma B) Invasive lobular carcinoma C) Medullary carcinoma D) Triple-negative breast cancer

D) Triple-negative breast cancer. Triple-negative breast cancer is most commonly associated with BRCA1 mutations. Invasive ductal and lobular carcinomas and medullary carcinoma have different genetic associations.

Acute mastitis: A. Usually develops at the beginning of breastfeeding B. Can progress to breast abscess C. Can progress to plasma cell mastitis D. A+B E. A+B+C

D. A+B Acute mastitis usually develops at the beginning of breastfeeding and can progress to breast abscess. While plasma cell mastitis is a chronic form of mastitis and is not necessarily a progression from acute mastitis.

3. Which breast disorder is most likely to occur during lactation and breast-feeding? A. Chronic mastitis B. Duct ectasia C. Fat necrosis D. Acute mastitis E. Fibrocystic changes

D. Acute mastitis It is caused by a bacterial infection that often develops when milk is not properly drained from the breast, leading to inflammation and pain. Chronic mastitis, duct ectasia, fat necrosis, and fibrocystic changes are all breast disorders that can occur in women who are not breastfeeding or lactating, although they may occur during pregnancy.

Inflammatory carcinoma is defined by an enlarged, swollen, erythematous breast that is due to: A. Pronounced lymphocytic infiltrate B. A special type of carcinoma C. Desmoplasia D. Blockage of numerous dermal lymphatic spaces by carcinoma E. Tumor cells present in the epidermis

D. Blockage of numerous dermal lymphatic spaces by carcinoma Inflammatory carcinoma is a rare and aggressive type of breast cancer that is characterized by the blockage of lymph vessels in the skin of the breast by cancer cells. This results in a characteristic appearance of the breast that is red, swollen, and warm to the touch, similar to an inflammatory reaction. The cancer cells in this type of carcinoma can grow and spread quickly, making it an especially dangerous form of breast cancer.

10. Inflammatory carcinoma is defined by enlarged, swollen, erythematous breast that is due to: A. Pronounced lymphocytic infiltrate B. Special type of carcinoma C. Desmoplasia D. Blockage of numerous dermal lymphatic spaces by carcinoma E. Tumor cells presented in epidermis

D. Blockage of numerous dermal lymphatic spaces by carcinoma Inflammatory carcinoma is defined by an enlarged, swollen, erythematous breast that is due to the blockage of numerous dermal lymphatic spaces by carcinoma cells. This blockage leads to a buildup of fluid and inflammation in the breast tissue, causing the characteristic redness and swelling. Inflammatory carcinoma is a rare and aggressive form of breast cancer that can be difficult to treat, and it is not defined by a pronounced lymphocytic infiltrate, a special type of carcinoma, desmoplasia, or tumor cells presented in the epidermis.

4. Which of the following is the most common type of breast carcinoma: A. Intraductal B. Mucinous C. Lobular invasive D. Ductal invasive E. Papillary invasive

D. Ductal invasive Ductal invasive carcinoma is the most common type of breast carcinoma, accounting for approximately 80% of all breast cancers. It originates in the cells lining the milk ducts of the breast and can spread to other parts of the body if not treated. Intraductal carcinoma, also known as ductal carcinoma in situ (DCIS), is a non-invasive form of breast cancer that is confined to the milk ducts and has not yet spread to other parts of the breast. Lobular invasive carcinoma and mucinous carcinoma are less common types of breast cancer, while papillary invasive carcinoma is a rare form of breast cancer.

1. An 21-year old women accidentally found in her left breast movable, sharply demarcated node, and went to her physician. An ultrasound was done, and there no doubts that the node is benign. Her mother was diagnosed as breast carcinoma several moths ago. What is most likely the lesion? A. breast adenosis B. breast carcinoma C. Fat necrosis D. Fibroadenoma E. Papilloma

D. Fibroadenoma Fibroadenomas are common benign breast tumors that often present as a movable, sharply demarcated node. They are more common in younger women and can be associated with a family history of breast cancer. Breast adenosis, fat necrosis, and papilloma may also present with a palpable mass, but are less likely given the description of the lesion. Breast carcinoma is less likely given the ultrasound findings indicating a benign lesion. However, it's important for the woman to continue to receive regular breast exams and screenings, particularly given her family history of breast cancer.

17-year old man noticed one-side breast enlargement in last few months. What is most likely lesion is: A. Fibrocystic disease B. Fibrosis C. Breast carcinoma D. Gynecomastia E. Sclerosing adenosis

D. Gynecomastia

A 52-year-old woman was diagnosed with ductal invasive steroid receptor-negative carcinoma, with HER-2/neu overexpression (3+ by immunohistochemistry). She also had 4 out of 15 positive lymph nodes. HER-2/neu overexpression is associated with: A. Steroid receptor status B. Histological type of tumor C. Better prognosis D. Poorer prognosis E. Tumor size

D. Poorer prognosis HER-2/neu overexpression is associated with a poorer prognosis in breast cancer. This is because HER-2/neu is a growth factor receptor that is overexpressed in some breast cancers, leading to increased proliferation of cancer cells and a more aggressive tumor phenotype. In this case, the patient has steroid receptor-negative (ER/PR-negative) breast cancer, which tends to be more aggressive, and HER-2/neu overexpression, which further increases the aggressiveness of the tumor. The fact that she also has positive lymph nodes suggests that the cancer has spread beyond the breast, which further worsens the prognosis.

Which of the following changes significantly (5-fold) increase the risk of breast carcinoma in women without family history of breast cancer? A. Sclerosing adenosis B. Atypical ductal hyperplasia C. Atypical lobular hyperplasia D. A+B E. A+B+C

E. A+B+C Atypical ductal hyperplasia (ADH) is a premalignant lesion of the breast that is associated with a significant (4-5 fold) increased risk of developing invasive breast cancer. Sclerosing adenosis and atypical lobular hyperplasia are also considered to be premalignant lesions but are associated with a less significant increased risk of developing breast cancer. However, the combination of multiple risk factors can further increase the overall risk of developing breast cancer. Therefore, D. A+B (sclerosing adenosis and atypical ductal hyperplasia) and E. A+B+C (sclerosing adenosis, atypical ductal hyperplasia, and atypical lobular hyperplasia) may also be considered as correct depending on the context of the question.

Which of the following findings in the primary breast carcinoma of a 45 year old woman suggests a better prognosis? A. Negativity for estrogen receptors B. A solitary lymph node metastasis C. A tumor size of 5 cm D. Aneuploidy by flow cytometry E. An intraductal histologic pattern

E. An intraductal histologic pattern

5. Important prognostic factors for patients with breast carcinoma include all of the following EXCEPT: A. Age of the patient B. Histologic type of tumor C. Presence of estrogen receptors in the tumor D. Presence of metastases E. Location of tumor in lateral breast quadrant

E. Location of tumor in lateral breast quadrant The location of the tumor in the lateral breast quadrant is not an important prognostic factor for patients with breast carcinoma. The other factors listed are all important prognostic factors for breast cancer patients. Age of the patient, histologic type of tumor, presence of estrogen receptors in the tumor, and presence of metastases all play a role in determining the aggressiveness of the cancer and the patient's likely outcome. Other important prognostic factors include tumor size, grade, and lymph node involvement.