Medical

Question 1

Type of crystals that can be seen in apocrine cysts

Answer 1

Oxalate crystals

Question 2

Adenosis can notmally be seen in _______ women. They often have a _____ lining.

Answer 2

Pregnant
Columnar

Question 3

MC non proliferative lesion of the breast
Pathogenesis
RF

Answer 3

FCC
Excess hormone secretion
Late age menopause, HRT, nulliparity, low BMI

Question 4

Morphology of FCC

Answer 4

Cysts
Stromal fibrosis
Apocrine metaplasia
CCC
Adenosis

Question 5

T or F: epithelial displacement is more common in papillary lesions

Answer 5

True

Question 6

T or F: when the epithelial fragments are confined to the biopsy site, a diagnosis of epithelial displacement should be favored.
A diagnosis of invasive carcinoma should only be made, if epithelium is found in the stroma away from the biopsy site

Answer 6

True

Question 7

T or F: silicone granuloma
Silicon leakage can be seen even without frank implant rupture .

Answer 7

True
Newer silicone implants have liquid silicone (at body temperature), which can migrate locally and distantly

Question 8

T or F: duct ectasia can primarily be seen in in perimenopausal and post menopausal women

Answer 8

True

Question 9

A 55 year old woman with type one diabetes mellitus type 1 came in due to bilateral breast masses. Microscopically lymphocytes were seen in periductal, perivascular, and perilobular areas.
Ihc?
Most likely dx?

Answer 9

Diabetic mastopathy/lymphocytic mastopathy/sclerosing lymphocytic lobulitis
CD20 (+) - the lymphocytes are B cells
It can be seen with other autoimmune disorders like Graves’ disease, Hashimoto’s, thyroiditis, pernicious, anemia, etc.

Question 10

A 45 year old woman came in due to bilateral breast masses and palpable axillary lymph nodes. She reveals that she’s had weight loss in the past months and blood work up showed increased eosinophils. Biopsy of the breasts was done. Microsections show dense lymphoplasmacytic infiltrates in a fibrotic stroma with storiform pattern and obliterative phlebitis. There were no neutrophils, granulomas or giant cells.
Dx?
Ihc?

Answer 10

IgG4 related mastitis
Increased IgG4 positive plasma cells (>40% igG4/IgG ratio)

Question 11

An 18 year old woman came in due to breast tenderness. She has a history of cough and sore throat. Biopsy of the breast was done microscopic sections show, nonspecific, lobulocentric granulomatous inflammation with epithelioid and spindled histiocytes, multi nucleated, giant cells, and a Central, lipid vacuole. Also seen are neutrophils, lymphocytes, plasma, cells, and eosinophils.
Diagnosis? Types

Answer 11

Granulomatous mastitis
Granulomatous lobular mastitis- parous women only
Cystic neutrophilic granulomatous mastitis- lipophilic Corynebacterium infections
Ddx: sarcoidosis, prior procedure

Question 12

Differentiate UDH from DCIS
CELL SIZE AND SHAPE
cell margins
Cell types
CK 5/6 staining
ER staining
UDH risk for breast cancer

Answer 12

UDH have cells that vary in size and shape. Cell margins are indistinct. There is an admixture of cell types (epithelial, myoepithelial, and/or apocrine) that stain with BOTH LMWCK (ck7) and HMWCK (ck5/6)
ER staining: heterogeneous (some on, some off)
2 fold increased risk

DCIS are monomorphic with distinct cell margins. Proliferating cells are EPITHELIAL which only stain with LMWCK. (Negative for CK 5/6)
ER staining is strong and diffuse

Question 13

Atypical ductal hyperplasia (ADH)
Criteria
Findings that increase likelihood for malignancy
RR for breast cancer?

Answer 13

</=2mm and <2 duct spaces
Multiple foci of ADH, marked nuclear atypia, micropapillary architecture
4-5 fold RR