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Mammary - 3. Dx > Generalities > Flashcards

Generalities Flashcards

1
Q

T/F. Painful breast masses are usually benign

A

True

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2
Q

The principal mammographic signs associated with carcinoma are ____ and ____

A

Densities and calcifications

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3
Q

Suspect cancer in a patient with nipple discharge if ____

A

Spontaneous and unilateral

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4
Q

Most common palpable masses

A
  • Cyst
  • Fibroadenoma
  • Carcinoma
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5
Q

Epithelial breast lesions are divided into these categories with respective risks of developing invasive carcinoma

A
  • Non-proliferative breast changes
  • Proliferative breast diseases without atypia
  • Proliferative breast diseases with atypia and carcinoma in situ
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6
Q

Nonproliferative breast changes (fibrocystic changes)

A
  • Duct ectasia
  • Cysts
  • Apocrine change
  • Adenosis
  • Fibroadenoma w/o complex features
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7
Q

Proliferative disease without atypia

A
  • Moderate or florid hyperplasia
  • Sclerosing adenosis
  • Papilloma
  • Complex sclerosing lesion (radial scar)
  • Fibroadenoma with complex features
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8
Q

Proliferative disease with atypia

A
  • Atypical ductal hyperplasia (ADH)
  • Atypical lobular hyperplasia (ALH)
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9
Q

Apatient presents 1 month after a benign right breast biopsy with a lateral subcutaneous cord felt just under the skin and causing pain. The etiology of this condition is?

  1. Fat necrosis
  2. Infection
  3. Superficial thrombophlebitis
  4. Suture granuloma
  5. Misdiagnosed breast cancer
A

Answer: 3

  • Superficial thrombophlebitis

Rationale:

  • This entity is known as Mondor’s disease and is caused by superficial thrombophlebitis usually induced by surgery, infection, or trauma
  • The process is self-limiting and resolves within 2–10 weeks
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10
Q

32/F. Biopsy showed fibrosis, increase in the number of acini per lobule, and cystic dilatation of the acini; some which show apocrine metaplasia. What is the diagnosis?

A

Fibrocystic change

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11
Q

34/F. Biopsy showed fibrocystic changes and areas showing ducts lined by more than 2 layers of cells with slit-like lumina at the periphery, and an intact myoepithelial layer. What is the diagnosis?

A

Epithelial hyperplasia

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12
Q

37/F. Biopsy showed cords and sheets of cells within a sclerotic stroma, with dilated ducts at the periphery. Immunohistochemistry: p63, CK5,6 (+). What is the diagnosis?

A

Sclerosing adenosis

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13
Q

35/F. Biopsy showed central nidus of entrapped glands within a hyalinized stroma, with fibrocystic changes and epithelial hyperplasia on adjacent areas. What is the diagnosis?

A

Complex sclerosing lesion/radial scar

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14
Q

27/F with bloody nipple discharge. Biopsy showed papillary fronds within a duct. Immunohistochemistry: p63, CK 5,6 (+). What is the diagnosis?

A

Intraductal papilloma

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15
Q
  1. 46/F presents with breast mass. If biopsy revealed monomorphic cells proliferating within the lobule of the acini, but the change is evident in only 10% of the acini in a lobule, what would be the diagnosis?
  2. If the change involves all of the acini in a lobule, what is the diagnosis?
A
  1. Atypical lobular hyperplasia (ALH)
  2. Lobular carcinoma in situ (LCIS)
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16
Q
  1. 46/F. Biopsy showed nests of monomorphic cells, and ducts filled with the same cells, showing cribriform pattern. The changes do not involve the whole duct. What is the diagnosis?
  2. Based on the case above, if the change involves the whole duct, what would be the diagnosis?
  3. Based on the second case, if there are dilated ducts lined by cells with high-grade nuclear atypia and central necrosis, what would be the specific diagnosis?
A
  1. Atypical ductal hyperplasia (ADH)
  2. Ductal carcinoma in situ (DCIS)
  3. Comedo DCIS
17
Q

45/F, with a rash on the nipple area. PE: (+) firm mass, on the upper outer quadrant of the breast. Biopsy of the rash showed large cells with mild nuclear atypia in the epidermis. Immunohistochemistry: Epithelial membrane antigen (EMA) (+). What is the diagnosis?

A

Paget disease of the nipple

18
Q

Stromal tumors

A
  • Fibroadenomas
  • Phyllodes tumor
  • Benign stromal lesions
  • Malignant stromal tumors
19
Q

If biopsy showed cords of medium-sized cells showing an Indian filing pattern, and cords of cells encircling a duct (targetoid pattern), and IHC for E-cadherin turned out to be negative, what is the diagnosis?

A

Invasive lobular carcinoma

20
Q

60/F, with a firm mass on the upper outer quadrant. Biopsy showed syncytium-like solid sheets of large cells with pleomorphic nuclei and prominent nucleoli, with high mitotic index, dense lymphoplasmacytic infiltrate, and pushing borders. Immunohistochemistry: ER, and HER-2 (-). what is the diagnosis?

A

Medullary carcinoma

21
Q

If biopsy showed nests of atypical cells, floating in pools of mucin, comprising 95% of the tumor, what is the diagnosis?

A

Pure mucinous carcinoma

22
Q

65/F, with breast pain, and a firm mass at the upper outer quadrant. PE: erythematous, (+) orange peel appearance of skin, tender breast. Biopsy showed solid sheets and nests of cells with high-grade nuclear atypia, and numerous mitotic figures. What is the diagnosis?

A

Inflammatory carcinoma

23
Q

25/F, with 2.0 cm mass. Biopsy showed proliferation of intralobular stroma that surrounds and compresses the ducts. What is the diagnosis?

A

Fibroadenoma

24
Q

50/F, with 6.0 cm mass. Biopsy showed intense proliferation of intralobular stroma with leaf-like processes lined by ductal epithelium; there is stromal hypercellularity, cellular atypia, and increaed mitotic index. What is the diagnosis?

A

Phyllodes tumor

25
Q

24/M, with bilateral areolar swelling. Excision was performed, and biopsy showed increase in connective tissue and epithelial hyperplasia of the ducts, without lobule formation. What is the diagnosis?

A

Gynecomastia

26
Q

T/F. Biopsy of any chronic nipple rash is mandatory

A

True; patient may have Paget disease of the breast

Mammary - 3. Dx (21 decks)

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