CARCINOMA BREAST - PATHOLOGY (4 MCQs)

3) 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

An intraductal carcinoma, or ductal carcinoma in situ (DCIS), may not produce a palpable mass. The necrosis of the neoplastic cells in the ducts leads to calcification, and the necrotic cells can be extruded from the ducts, giving rise to the term comedocarcinoma. Such intraductal carcinomas represent about one fourth of all breast cancers. If not excised, such lesions become invasive. Intraductal carcinoma has several other histologic patterns, including noncomedo DCIS and Paget disease of the nipple, in which extension of the malignant cells to the skin of the nipple and areola produces the appearance of a seborrheic dermatitis. 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 both stromal and glandular components.

4) A female patient presented with a firm mass of 2 x 2 cm in the upper outer quadrant of the breast. She gives a family history of ovarian carcinoma. The investigation that needs to be done to assess for mutations is: a. p53 b. BRCA 2 c. Her2/Neu gene d. C myc gene

Ans: (b)

1) A 26-year-old woman has felt a breast lump for the past month. She has a family history of early onset 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 shows carcinoma. Genetic analysis shows that she is a carrier of the BRCA1 gene mutation, as are her mother and sister. Which type 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

Patients with the BRCA1 gene mutation have a high incidence of medullary carcinomas that are poorly differentiated, do not express the HER2/neu (ERBB2) protein, and are negative for estrogen and progesterone receptors

2) A 67- year - old woman, with a 25 year smoking history, on hormone replacement therapy, presents because a recent increase in size of her right breast. On examination, there is a nontender, mobile, nodular 3 cm mass in the left breast. The right breast is significantly larger than the left and has a 'teardrop' appearance. What is the most likely diagnosis? a. Paget disease of the nipple b. Inflammatory breast carcinoma c. Breast abscess d. Malignant phyllodes tumour e. Fibroadenoma

The most likely answer here is a malignant phyllodes tumour which accounts for 0.5 per cent of all breast tumours. The recent increase in size of the right breast coupled with the discovery of a non-tender, mobile lump, giving the right breast a 'tear drop' appearance, is suggestive of a malignant phyllodes tumour. Phyllodes tumours have many of the clinical and histological features of fibroadenomas (which are common in women in their early to late twenties) Inflammatory breast carcinoma is associated with pain (unlike other breast cancers), breast erythema, peau d'orange (the skin overlying the breast resembles that of orange peel) and skin ridging with or without a palpable mass. Paget disease of the nipple presents as a unilateral, non-itchy irregular eczematous eruption of the nipple. It can be easily confused with eczema of the nipple, which usually occurs bilaterally, with pruritus, and can be nipple sparing.