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. 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?]] |
| 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. |
| 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 |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |