Generalities Flashcards
T/F. Painful breast masses are usually benign
True
The principal mammographic signs associated with carcinoma are ____ and ____
Densities and calcifications
Suspect cancer in a patient with nipple discharge if ____
Spontaneous and unilateral
Most common palpable masses
- Cyst
- Fibroadenoma
- Carcinoma
Epithelial breast lesions are divided into these categories with respective risks of developing invasive carcinoma
- Non-proliferative breast changes
- Proliferative breast diseases without atypia
- Proliferative breast diseases with atypia and carcinoma in situ
Nonproliferative breast changes (fibrocystic changes)
- Duct ectasia
- Cysts
- Apocrine change
- Adenosis
- Fibroadenoma w/o complex features
Proliferative disease without atypia
- Moderate or florid hyperplasia
- Sclerosing adenosis
- Papilloma
- Complex sclerosing lesion (radial scar)
- Fibroadenoma with complex features
Proliferative disease with atypia
- Atypical ductal hyperplasia (ADH)
- Atypical lobular hyperplasia (ALH)
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?
- Fat necrosis
- Infection
- Superficial thrombophlebitis
- Suture granuloma
- Misdiagnosed breast cancer
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
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?
Fibrocystic change
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?
Epithelial hyperplasia
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?
Sclerosing adenosis
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?
Complex sclerosing lesion/radial scar
27/F with bloody nipple discharge. Biopsy showed papillary fronds within a duct. Immunohistochemistry: p63, CK 5,6 (+). What is the diagnosis?
Intraductal papilloma
- 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?
- If the change involves all of the acini in a lobule, what is the diagnosis?
- Atypical lobular hyperplasia (ALH)
- Lobular carcinoma in situ (LCIS)
- 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?
- Based on the case above, if the change involves the whole duct, what would be the diagnosis?
- 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?
- Atypical ductal hyperplasia (ADH)
- Ductal carcinoma in situ (DCIS)
- Comedo DCIS
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?
Paget disease of the nipple
Stromal tumors
- Fibroadenomas
- Phyllodes tumor
- Benign stromal lesions
- Malignant stromal tumors
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?
Invasive lobular carcinoma
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?
Medullary carcinoma
If biopsy showed nests of atypical cells, floating in pools of mucin, comprising 95% of the tumor, what is the diagnosis?
Pure mucinous carcinoma
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?
Inflammatory carcinoma
25/F, with 2.0 cm mass. Biopsy showed proliferation of intralobular stroma that surrounds and compresses the ducts. What is the diagnosis?
Fibroadenoma
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?
Phyllodes tumor
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?
Gynecomastia
T/F. Biopsy of any chronic nipple rash is mandatory
True; patient may have Paget disease of the breast
