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: 1- Comedo 2- Cribriform 3- Papillary 4- Micropapillary 5- Solid 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. Educational Objective: Comedocarcinoma of the breast is characterized by the presence of central necrosis. References: Pinder SE. Ductal carcinoma in situ (DCIS) pathological features, differential diagnosis, prognostic factors, and specimen evaluation. Mod Pathol. 2010;23:S8-S13. Richie RC, Swanson JO. Breast cancer: a review of the literature. J Insur Med. 2003;35:85-101. Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102(3):170-8 First Aid 2014 page 585]]
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
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