JCU MB4 Term 4 Week 5 (Breast pathology)

1

52yo woman, right breast lump for 7 months. O/E hard, irregular, 6cm mass in RUOQ. No palpable axillary lymph nodes. Lab report shows ER and PR 4+, HER2/neu negative. Image shows clinical and gross mastectomy tissue. What is the most likely diagnosis?

Breast scirrhous carcinoma


2

47yo female, mastalgia, creamy discharge for 4 months. What is the diagnosis?

Duct ectasia


3

47yo female, cyclical mastalgia. Gross mastectomy specimen shown. What is the diagnosis?

Breast fibrocystic disease


4

71yo female, scaly lesion on breast over a 5cm mass. ER/PR negative, HER2 positive. What is the diagnosis?

Breast Paget's disease


5

71yo female, scaly lesion on breast over 5cm mass. Image shows biopsy. What is the feature shown the arrow?

Breast lymphatic invasion


6

51yo female, slowly enlarging mass for 4 years. No family history of breast cancer, examination reveals 7cm, firm, mobile mass. Mammography image shown. What is the diagnosis?

Breast cystosarcoma phyllodes


7

41yo female, biopsy shown following suspicious result on mammography. What microscopy feature is seen?

Breast infiltrating adenocarcinoma


8

26yo female, 3 weeks postpartum. Swollen painful mass RUOQ of breast. Gross appearance and microscopy shown. What is the diagnosis?

Breast acute mastitis


9

51yo female presents with retracted, atrophic nipple. Gross specimen shown. What is the diagnosis?

Breast duct carcinoma


10

What microscopy features are most common in duct carcinoma of the breast?


11

21yo female, mobile lump becomes tender and large before each menstrual cycle. Mammography is shown. What is the diagnosis?

Breast fibroadenoma mammography


12

A 35yo nulliparous woman complains that her breasts are swollen and nodular upon palpation. A mammogram discloses foci of calcification in both breasts. A breast biopsy (shown) reveals cystic duct dilation and ductal epithelial hyperplasia with atypia. What is the appropriate diagnosis?

Breast DCIS


13

A 53yo woman discovers a lump in her breast and physical examination confirms a mass in the lower, outer quadrant of the left breast. Mammography demonstrates an ill-defined, stellate density measuring 1cm with microcalcification. Following needle aspiration, a modified radical mastectomy is performed. The surgical specimen is shown. Which of the following cellular markers would be the most useful to evaluate before considering therapeutic options for this patient?

Breast carcinoma


14

27yo female presents with RLQ 8mm mobile breast mass. Microscopy shown. What is the diagnosis?

Breast fibroadenoma


15

32yo female, 6cm right breast mass. Microscopy shown. What is the diagnosis?

Breast cystosarcoma phyllodes


16

36yo female presents with 3mm breast mass. Mammogram is shown. What is the diagnosis?

Breast carcinoma NST


17

48yo female presents with blood nipple discharge and a lump. Microscopy shown. What is the diagnosis?

Breast duct papilloma


18

48yo female, breast has bloody dischartge. Microscopy shown. What is the diagnosis?

Breast DCIS


19

51yo female presents with breast carcinoma - T3N2M1. What is the pathogenesis of the feature indicated by the arrow?

Breast orange peel


20

48yo female presents with eczematous patch on breast. External appearance shown. What is the diagnosis?

Breast eczematous patch


21

A 20yo woman asks for your advice regarding her risk of developing breast cancer. Her mother, maternal aunt, and maternal grandmother all developed breast cancer. She would like to know if she has a genetic predisposition. Laboratory tests for mutations in which of the following genes would be most likely to answer your patient's question?


22

A 34yo woman presents with an irregular breast lump in the LUOQ. The lump seems to be increasing with every menstrual cycle. Following non-diagnostic FNAC, biopsy was done and image shows the typical feature seen. What is the most likely diagnosis?

Breast fibrocystic disease


23

48yo female, mammogram shown. What is the diagnosis?

Breast scirrhous carcinoma


24

A 26yo woman presents with a breast mass that was detected on self-examination one week earlier. Mammography reveals a round, sharply demarcated 3cm nodule in the right breast (shown). Biopsy of the breast mass shown neoplastic epithelial ductal structures situated within a fibromyxoid stroma. The patient refuses further treatment and informs you that she wishes to become pregnant. Which of the following is the most likely effect of pregnancy on this breast lesion?

Breast nodule


25

A 35yo woman consults her family physician because of painful swelling of her breasts. Particularly as she approaches the end of her menstrual cycle. On self-examination she recently felt a tender nodule in the right breast. Physical examination reveals an irregular nodularity of both breasts with diffuse tenderness. Examination of the axilla is negative. A mammogram demonstrates irregular areas of density in the lower outer quadrants of both breasts. Which of the following histopathologic features is considered to be a risk factor for the development of carcinoma in this patient?


26

A 58yo woman presents with a suspcious density found on routine mammography. No axillary lymphadenopathy, excision biopsy was done and image shows the typical feature seen. What is the most likely diagnosis?

Breast DCIS


27

A 30yo woman presents with whitish nipple discharge of 3 weeks duration. The patient has not menstruated for the past 4 months (previously normal), and pregnancy test is negative. The breasts are firm and non-tender. On further questioning she describes a morning headache and vision problems for a few months. A cytologic smear of the discharge shows no evidence of acute or chronic inflammation. Which of the following is the most likely cause in this patient?


28

44yo female presents with breast mass. Gross specimen shown. What is the diagnosis?

Breast carcinoma


29

44yo female presents with breast mass, gross specimen shown. What is the diagnosis?

Breast fibroadenoma


30

44yo female presents with breast mass, gross specimen shown. Which of the following describes its appearance correctly?

Breast radial scar