WBR0724: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Oncology
|SubCategory=Oncology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Oncology
|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. Needle biopsy of the mass is performed and the diagnosis of comedocarcinoma of the breast is made.  Which of the following pathological findings is characteristic of comedocarcinoma of the breast?
|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. Needle biopsy of the mass is performed, and the 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:
|Explanation=Ductal carcinoma in situ (DCIS) contains several subtypes that are classified based on the architecture of the proliferation:
1- Comedo
1- Comedo
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5- Mixed
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.   
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. Comedocarcinoma is an in-between 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
|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.
|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.
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|AnswerE=Central necrosis
|AnswerE=Central necrosis
|AnswerEExp=Central necrosis is characteristic of comedocarcinoma of the breast
|AnswerEExp=Central necrosis is characteristic of comedocarcinoma of the breast
|EducationalObjectives=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.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=breast, cancer, comedo, carcinoma, comedocarcinoma, indian, file, central, necrosis, cribriform, subtype, DCIS, ductal, carcinoma, in situ, cystic
|WBRKeyword=breast, cancer, comedo, carcinoma, comedocarcinoma, indian, file, central, necrosis, cribriform, subtype, DCIS, ductal, carcinoma, in situ, cystic
|Approved=No
|Approved=No
}}
}}

Revision as of 02:14, 16 September 2014
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. Needle biopsy of the mass is performed, 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 seen 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) 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. Comedocarcinoma is an in-between 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.
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.]]

Approved Approved::No
Keyword WBRKeyword::breast, WBRKeyword::cancer, WBRKeyword::comedo, WBRKeyword::carcinoma, WBRKeyword::comedocarcinoma, WBRKeyword::indian, WBRKeyword::file, WBRKeyword::central, WBRKeyword::necrosis, WBRKeyword::cribriform, WBRKeyword::subtype, WBRKeyword::DCIS, WBRKeyword::ductal, WBRKeyword::carcinoma, WBRKeyword::in situ, WBRKeyword::cystic
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