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{{WBRQuestion
|QuestionAuthor={{Rim}}
|ExamType=USMLE Step 1
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|SubCategory=Oncology
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Oncology
|Prompt=A 58 year old woman, previously healthy, 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. Appropriate work-up is initiated; needle biopsy of the mass is performed and that diagnosis of comedocarcinoma of the breast is made.  Which of the following pathological findings is characteristic of comedocarcinoma of the breast?
|Explanation=Ductal carcinoma in situ (DCIS) contains several subtypes that are classified based on the architecture of the proliferation:
1- Comedo
2- Cribriform
3- Micropapillary
4- Solid
5- Mixed

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 than other types and is in between a state of in-situ cancer and an invasive one. It is frequently detected by mammography.  

Educational Objective: Comedocarcinoma of the breast is characterized by the presence of central necrosis.

Reference:

Pinder SE. Ductal carcinoma in situ (DCIS) pathological features, differential diagnosis, prognostic factors, and specimen evaluation. Modern Pathology. 2010; 23:S8-S13.

Richie RC, Swanson JO. Breast cancer: a review of the literature. J Insur Med. 2003; 35:85-101.
|AnswerA="Indian file" pattern
|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.
|AnswerB=Neutrophilic infiltration
|AnswerBExp=Neutrophilic infiltration is typical of inflammatory conditions, such as acute mastitis.
|AnswerC=Cystic features
|AnswerCExp=Cystic features are characteristic of fibrocystic change/fibrocystic disease.
|AnswerD=Cribriform structures
|AnswerDExp=Cribriform structures are seen in cribriform subtype of ductal carcinoma in situ (DCIS).
|AnswerE=Central necrosis
|AnswerEExp=Central necrosis is characteristic of comedocarcinoma of the breast
|RightAnswer=E
|WBRKeyword=breast, cancer, comedo, carcinoma, comedocarcinoma, indian, file, central, necrosis, cribriform, subtype, DCIS, ductal, carcinoma, in situ, cystic
|Approved=No
}}