GP THE BREAST CASES Flashcards
A 21-year-old woman delivered a normal term infant a
week ago and is now nursing the infant. She now notes a lump in her right axilla that has increased in size over the past week. On physical examination there is a rubbery, mobile, 1.5-cm mass beneath the skin at the right anterior axillary line. The mass is excised and the microscopic appearance is shown in the figure. Which of the following hormones most likely produced the greatest effect upon this tissue?
Prolactin
A 24-year-old woman is breastfeeding 3 weeks after
giving birth to a normal term infant. She notices fissures in the skin around her left nipple. Over the next 3 days, a 5-cm region near the nipple becomes erythematous and tender. Purulent exudate from a small abscess drains through a fissure. Which of the following organisms is most likely to be cultured from the exudate?
Staphylococcus aureus
A 30-year-old woman sustained a traumatic blow to
her right breast. Initially, there was a 3-cm contusion beneath the skin that resolved within 3 weeks, but she then felt a firm, painless lump that persisted below the site of the bruise 1 month later. What is the most likely diagnosis for this lump?
Fat necrosis
A study of mammographic findings on women of reproductive years is performed. The study identifies mammograms showing 1- to 5-cm cysts with focal microcalcifications and surrounding densities. Subsequent fine-needle aspiration yielded turbid fluid with few cells. Which of the following microscopic changes is most likely to be present in these lesions?
Apocrine metaplasia
A 27-year-old woman feels a lump in her right breast.
She has normal menstrual cycles, she is G3, P3, and her last child was born 5 years ago. On examination a 2-cm, irregular, firm area is palpated beneath the lateral edge of the areola. This lumpy area is not painful and is movable. There are no lesions of the overlying skin and no axillary lymphadenopathy. A biopsy specimen shows microscopic evidence of an increased number of dilated ducts surrounded by fibrous connnective tissue. Fluid-filled ducts with apocrine metaplasia also
are present. What is the most likely diagnosis?
Fibrocystic changes
A 47-year-old woman has a routine health examination.
There are no remarkable findings except for a barely palpable mass in the right breast. A mammogram shows an irregular, 1.5-cm area of density with scattered microcalcifications in the upper outer quadrant. A biopsy specimen from this area is obtained and microscopically shows ductal hyperplasia. Which
of the following is the most appropriate option for follow-up of this patient?
Continued screening for breast cancer
A 34-year-old woman has noticed a bloody discharge
from the nipple of her left breast for the past 3 days. On physical examination, the skin of the breasts appears normal, and no masses are palpable. There is no axillary lymphadenopathy. She has regular menstrual cycles and is using oral contraceptives. Excisional biopsy is most likely to show which of the following lesions in her left breast?
Intraductal papilloma
A 57-year-old man has developed bilateral breast enlargement over the past 2 years. On physical examination, the enlargement is symmetric and is not painful to palpation. There are no masses. He is not obese and is not taking any medications. Which of the following underlying conditions best accounts for his findings?
Micronodular cirrhosis
A 58-year-old woman sees her naturopathic health
care provider for a routine health examination. There are no remarkable findings on physical examination. A screening mammogram shows a 0.5-cm irregular area of increased density with scattered microcalcifications in the upper outer quadrant of the left breast. Excisional biopsy shows atypical lobular hyperplasia. She has been on postmenopausal estrogen-progesterone therapy for the past 10 years. She has smoked 1 pack of cigarettes per day for the past 35 years. Which of the
following is the most significant risk factor for the development of lobular carcinoma in patients with such lesions?
Atypical cytologic changes
A 25-year-old Jewish woman sees her physician after
finding a lump in her right breast. On physical examination, a 2-cm, firm, nonmovable mass is palpated in the upper outer quadrant. No overlying skin lesions and no axillary lymphadenopathy are present. The figure shows an excisional biopsy specimen. The family history indicates that the patient’s mother, maternal aunt, and maternal grandmother have had
similar lesions. Her 18-year-old sister has asked a physician to determine whether she is genetically at risk of developing a similar disease. A mutated gene encoding for which of the following is most likely to be found in her sister?
BRCA1
A clinical study is performed on postmenopausal women living in Paris, France, who are between the ages of 45 and 70 years. All have been diagnosed with infiltrating ductal carcinoma positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for HER2 expression, which has been confirmed by biopsy and microscopic examination of tissue. None has the BRCA1 or BRCA2 mutation. Which of the following is most likely to indicate the highest relative risk of developing the carcinomas seen in this group of women?
First-degree relative with breast cancer
A 54-year-old woman feels a lump in her left breast. On
examination there is a firm, irregular mass in the lower outer quadrant. A mammogram shows a 2-cm density with focal microcalcifications. Excisional biopsy shows intraductal and invasive carcinoma. Immunohistochemical staining is negative
for estrogen receptor (ER). FISH analysis (green = HER2; red = chromosome 17 centromere) shows the findings in the figure. When combined with doxorubicin, which of the following drugs is most likely to be useful in treating this patient?
Trastuzumab
A 66-year-old nulliparous woman received hormone replacement therapy for 7 years following menopause at age 53 years. Her BMI is 33. She now undergoes screening mammography, and an irregular mass is identified in the right breast. An excisional biopsy yields a 1.5-cm mass that microscopically has
invasive cells that are positive for estrogen receptor but negative for HER2, with low proliferation markers and mutated PIK3CAgene. Following surgical removal of the mass, which of the following clinical courses will most likely occur over the next year?
Very low likelihood of recurrence
A 63-year-old woman has a screening mammogram that shows an irregular density with microcalcifications. On physical examination, there are no lesions of the overlying skin, and there is no axillary lymphadenopathy. An excisional biopsy specimen shows no mass on sectioning. Microscopic examination shows the findings in the figure. What is the most likely
diagnosis?
Ductal carcinoma in situ
A 48-year-old woman has noticed a red, scaly area of
skin on her left breast that has grown slightly larger over the past 4 months. On physical examination, there is a 1-cm area of eczematous skin adjacent to the areola. The figure shows the microscopic appearance of the skin biopsy specimen. What is the most likely diagnosis?
Paget disease of the breast
