WBR0724
| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Oncology |
| Prompt | [[Prompt::A 58-year-old woman with no past medical history presents to the physician's office for a breast lump that she discovered incidentally while showering. Upon further questioning, she reports that she never visits her primary care physician and does not undergo yearly mammography screening. Following appropriate work-up, needle biopsy of the mass is performed. Two days later, results of the needle biopsy return, and the diagnosis of comedocarcinoma of the breast is made. Which of the following pathological findings is characteristic of comedocarcinoma of the breast?]] |
| Answer A | AnswerA::"Indian file" pattern |
| Answer A Explanation | AnswerAExp::"Indian file" pattern is the linear alignment of lobular cancerous cells that infiltrate through the dense fibrous stroma. It is characteristic of lobular carcinoma. |
| Answer B | AnswerB::Neutrophilic infiltration |
| Answer B Explanation | AnswerBExp::Neutrophilic infiltration is typical of inflammatory conditions, such as acute mastitis. |
| Answer C | AnswerC::Cystic features |
| Answer C Explanation | AnswerCExp::Cystic features are characteristic of fibrocystic change/fibrocystic disease. |
| Answer D | AnswerD::Cribriform structures |
| Answer D Explanation | AnswerDExp::Cribriform structures are observed in cribriform subtype of ductal carcinoma in situ (DCIS). |
| Answer E | AnswerE::Central necrosis |
| Answer E Explanation | AnswerEExp::Central necrosis is characteristic of comedocarcinoma of the breast |
| Right Answer | RightAnswer::E |
| Explanation | [[Explanation::Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer that causes a wide clinical spectrum of disease. It is often considered to be an intermediate step before progression to invasive breast cancer. DCIS is characterized by the presence of malignant epithelial cell proliferation bounded by the basement membrane of the breast ducts with no invasion to the basal myoepithelial layer. Accordingly, the presence of well-defined breast ducts is required for the diagnosis of DCIS. Based on the grade of the breast lesion, DCIS may be classified as low-grade, intermediate, or high-grade. DCIS is frequently detected by mammography. Management ranges from local excision, lumpectomy, breast-conserving surgery, to partial or total mastectomy with or without radiation, chemotherapy, or hormonal therapy.
DCIS contains several subtypes that are classified based on the architecture of the proliferation: However, patients usually present with lesions that involve more than 1 subtype or are said to have mixed lesions. Comedocarcinoma of the breast is characterized by the presence of cancerous cells surrounded by central necrosis. It is considered a more malignant form of DCIS compared to other subtypes, but is still an in-between state of in-situ cancer and an invasive cancer. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Breast, WBRKeyword::Cancer, WBRKeyword::Comedo, WBRKeyword::Carcinoma, WBRKeyword::Comedocarcinoma, WBRKeyword::Indian file, WBRKeyword::Central, WBRKeyword::Necrosis, WBRKeyword::Cribriform, WBRKeyword::Subtype, WBRKeyword::DCIS, WBRKeyword::Ductal, WBRKeyword::In situ, WBRKeyword::In-situ, WBRKeyword::Cystic |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |