Breast pathology DDx

Question 1

Case 1: breast lump

Physical exam: vague nodularity, bilateral, tendency to increase before menses, skin normal, no axillary LN.

Suggests abnormal response to hormones

Answer 1

• non-proliferative Fibrocystic change (FCC)
• proliferative FCC w/o atypia
• proliferative disease w atypia

Question 2

Case 2: breast lump

Physical exam : hard irregular lump (suggests malignancy) , borders not well defined ( suggests infiltration )

Yet not malignant

Answer 2

• Sclerosing adenosis

Question 3

Case 3: Postpartum female w enlargement and pain in her left breast; reddish and the nipple was cracked.

Answer 3

• Acute mastitis (abscess)
• mammary duct ectasia
• traumatic fat necrosis
• reaction to implants

Question 4

Case 4: breast lump, well delineated, mobile, not fixed to surrounding tissue. The skin was normal, no LN ,no inflammation

Answer 4

• benign tumour
  
  • fibroadenoma
  • phylloides tumour
• carcinoma
• FCC

Question 5

Case 5: Subareolar lump serous discharge from her right nipple. The nipple was retracted. No signs of inflammation.

Answer 5

• intraduct papilloma
• duct ectasia
• carcinoma ( comedo carcinoma)

Question 6

Case 6: breast lump ocated in upper outer quadrant, firm, ill defined borders, overlying skin dimpled and adherent to the mass, axillary LN enlarged.

Answer 6

• carcinoma
  
  • duct (90%)
  • lobular (10%)
• Noninfiltrating (insitu)
• Intraduct Carcinoma:(Comedo, Papillary,Paget’s)
• Lobular Carcinoma In situ (LCIS): absence of glandular cells
• Infiltrating Carcinoma
  
  • Duct :(Scirrhous,Medullary,

Colloid)

* Lobular