WBR0724

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Oncology
Prompt	[[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?]]
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 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. Educational Objective: References: ]]
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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