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


  Ductal carcinoma in-situ

  Cystosarcoma phyllodes

  Medullary carcinoma

  Fibrocystic disease

  Scirrhous carcinoma

2

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

Duct ectasia


  Breast carcinoma

  Paget's disease of breast

  Duct ectasia

  Fibrocystic disease

  Fibroadenoma

3

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

Breast fibrocystic disease


  Breast carcinoma

  Paget's disease of breast

  Duct ectasia

  Fibrocystic disease

  Fibroadenoma

4

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

Breast Paget's disease


  Breast carcinoma

  Paget's disease of breast

  Duct ectasia

  Basal cell carcinoma

  Psoriasis

5

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

Breast lymphatic invasion


  Dyskeratosis

  Lymphatic invasion

  Fibrocystic disease

  Infiltrating adenocarcinoma

  Lymphangitis

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


  Scirrhous carcinoma

  Medullary carcinoma

  Cystosarcoma phyllodes

  Fibroadenoma

  Blue dome cyst

7

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

Breast infiltrating adenocarcinoma


  Branching leaf like glands

  Epithelial proliferation

  Fibrocystic change

  Slit-like glands in loose stroma

  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


  Duct papilloma

  Duct ectasia

  Infiltrating duct carcinoma

  Acute mastitis

  Granulomatous mastitis


Within lactation period. Young, short duration; malignancy unlikely.

9

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

Breast duct carcinoma


  Phyllodes tumour

  DCIS

  Duct ectasia

  Fibrocystic disease

  Duct carcinoma

10

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


  Slit-like glands in areolar stroma

  Branching glands in cellular stroma

  Plenty of inflammatory cells within ducts

  Sheets of pleomorphic cells and inflammatory cells

  Dense fibrous stroma and clusters of pleomorphic cells

11

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

Breast fibroadenoma mammography


  Scirrhous carcinoma

  Medullary carcinoma

  Cystosarcoma phyllodes

  Fibroadenoma

  Blue dome cyst

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


  Ductal carcinoma in situ

  Fibroadenoma

  Simple fibrocystic change

  Proliferative fibrocystic change

  Intraductal papilloma

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


  P53 mutation

  BRCA1 gene amplification

  BRCA2 gene amplification

  Oestrogen receptors

  BCL and Rb gene mutation

14

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

Breast fibroadenoma


  Breast carcinoma

  Phyllodes tumours

  Giant fibroadenoma

  Duct papilloma

  Fibroadenoma

15

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

Breast cystosarcoma phyllodes


  Infiltrating duct carcinoma

  Cystosarcoma phyllodes

  Medullary adenocarcinoma

  Fibrocystic disease

  Fibroadenoma

16

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

Breast carcinoma NST


  Breast cancer NST

  Cystosarcoma phyllodes

  Medullary carcinoma

  Fibrocystic disease

  Fibroadenoma

17

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

Breast duct papilloma


  Papillary carcinoma

  Cystosarcoma phyllodes

  Duct papilloma

  Fibrocystic disease

  Ductal carcinoma in-situ

18

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

Breast DCIS


  Papillary carcinoma

  Cystosarcoma phyllodes

  Duct papilloma

  Ductal carcinoma in-situ

  Duct ectasia

19

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

Breast orange peel


  Inflammation

  Duct carcinoma

  Lymphoedema

  Duct papilloma

  Metastases

20

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

Breast eczematous patch


  Papillary carcinoma

  Paget's disease of breast

  Fat necrosis

  Peau d'orange

  Duct ectasia

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?


  P53

  BRCA1

  Oestrogen receptor

  HER2/neu

  Progesterone receptor

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


  Cystosarcoma phyllodes

  Fibroadenoma

  Ductal carcinoma in-situ

  Fibrocystic disease

  Duct ectasia


Some ducts appear full/congested; DCIS may also be a reasonable assessment.

23

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

Breast scirrhous carcinoma


  Papillary carcinoma

  Medullary carcinoma

  Traumatic fat necrosis

  Scirrhous duct carcinoma

  Fibrocystic disease

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


  Develops into DCIS

  Atrophy/decrease in size

  Progress to ductal carcinoma

  Rapid growth

  Metastasis to CNS

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?


  Epithelial hyperplasia

  Periductal inflammation

  Large cystic glands

  Duct ectasia, inflammation

  Stromal dense fibrosis

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


  Cystosarcoma phyllodes

  Fibroadenoma

  Ductal carcinoma in-situ

  Fibrocystic disease

  Duct ectasia

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?


  Fibroadenoma of breast

  Pituitary adenoma

  Sheehan syndrome

  Oral contraceptive therapy

  Fibrocystic change in breast

28

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

Breast carcinoma


  Breast carcinoma

  Giant fibroadenoma (phyllodes)

  Duct ectasia

  Fibrocystic disease

  Fibroadenoma

29

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

Breast fibroadenoma


  Breast carcinoma

  Giant fibroadenoma (phyllodes)

  Duct ectasia

  Fibrocystic disease

  Fibroadenoma

30

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

Breast radial scar


  Well-demarcated nodule

  Diffuse fibrosis with cysts

  Radial scar with nipple retraction

  Grey-white leaf-like folds

  Grey-white expanding tumour with nipple retraction