BREAST PATHOLOGY

Question 1

Unilateral breast mass

bloodly nipple discharge

Fixation to underlying chest wall

Gross: firm to hard , irregular border

Microscopy: extensive desmoplasia, tubules, solid clusters or single infiltrating cells with necrosis and atypical mitoses

Answer 1

Invasive Ductal Carcinoma

Question 2

Mechanism responsible for this appearance

Answer 2

Dermal lymphatic invasion by malignant tumor cells

Question 3

6th decade

unilateral breast mass

Gross: Bulbous protrusions

Microscopy: increased stromal cellularity and overgrowth –> leaflike architecture

Answer 3

Phyllodes Tumor

Question 4

List 4 causes for pathologic gynecomastia

Answer 4

Cirrhosis MCC

Klinefelter syndrome

spironolactone, ketoconazole

Leuprolide

Question 5

List 4 causes for galactorrhea

Answer 5

Physiologic

Prolactinoma

Primary hypothyroidism

Drugs-eg: H₂-receptor blockers

Question 6

vitamin A deficiency associated with smoking

keratinizing squamous metaplasia of the nipple ducts

painful erythematous subareolar mass

Answer 6

Periductal Mastitis

Question 7

30 year old female

discrete movable, painless breast mass

Gross: §well-circumscribed, rubbery, grayish white nodules that bulge, slitlike spaces

Microscopy: See attached image

Answer 7

Fibroadenoma

Question 8

1. Diagnosis?

•malignant clonal population of cells limited to ducts and lobules by the basement membrane.

solid sheets of pleomorphic cells with “high-grade” hyperchromatic nuclei and areas of central necrosis

2. Mammography feature of this condition

Answer 8

1. DCIS- comedo type
2. clusters or linear and branching microcalcifications

Question 9

Diagnosis?

Bloody nipple discharge

See attached image

Answer 9

Intraductal papilloma

Question 10

What is the mcc of this lesion?

Localized, firm breast mass

M/E: irregular steatocytes with no peripheral nuclei

pink amorphous necrotic material and inflammatory cells

foreign body giant cells

lipid laden macrophages

Answer 10

breast trauma or prior surgery.

Question 11

List the morphologic changes assoc with fibrocystic change

Answer 11

Cystic change

apocrine metaplasia

Fibrosis

Adenosis

Question 12

1. Diagnosis?

Breast mass

dyscohesive infiltrating tumor cells, in single file or in loose clusters or sheets

minimal desmoplasia

2. An important feature to note in terms of laterality of this tumor?

Answer 12

1. Invasive Lobular Carcinoma
2. 20% are bilateral

Question 13

unilateral erythematous eruption with a scale crust

bloody nipple discharge

pruritus+/-

Answer 13

Paget disease

Question 14

• 50-60 years
• poorly defined palpable periareolar mass
• •Greenish brown nipple discharge
• M/E: Chronic inflammation and fibrosis surround an ectatic duct filled with inspissated debris

Answer 14

Mammary Duct Ectasia

Question 15

Causes for granulomatous mastitis

Answer 15

Silicone implants

Sarcoidosis

Wegner’s granulomatosis

Mycobacterial/ fungal infections

Question 16

Breastfeeding new mother

Infant with cleft palate

Mother presents with erythema and pain in the breast, has fever

Answer 16

Acute mastitis

Question 17

Most important prognostic factor for breast carcinomas in the absence of distant metastasis

Answer 17

Axillary lymph node status