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Question 3: A 15-year-old healthy girl of normal height and Question 5: A 19-year-old woman gave birth to a healthy
weight for age is concerned because her right breast has male infant at term following an uncomplicated pregnancy.
developed to twice the size of her left breast since the onset She has now been breast feeding the baby for a month, but
notes that her left breast has gradually become swollen and
E Sclerosing adenosis
painful to touch over the past week. On physical examination
her temperature is 38.2°C. Which of the following is the most
(C) CORRECT. Galactocele occurs secondary to obstruction of
likely diagnosis?
lactiferous ducts. It is a non-neoplastic process. Following
A Acute mastitis cessation of lactation milk may be retained and produce a
cystic lesion. Aspiration of the cyst removes the fluid and the
B Fibrocystic disease
cyst collapses. The cyst is lined by cuboidal to flat epithelium.
C Fat necrosis The cyst contents often appear milky, but microscopically
contain inflammatory cells and/or necrotic debris.
D Intraductal papilloma Extravasation of the milk may produce chronic inflammation
E Galactocele and even fat necrosis.
(A) CORRECT. The causative organism is most Question 8: A 49-year-old woman notes increasing size to her
often Staphylococcus aureus or Streptococcus. Antibiotic right breast over the past year. This breast is not painful, but
therapy is usually successful. the heaviness causes some discomfort. On physical
examination the overlying skin and nipple appear normal.
Question 6: A 35-year-old woman has noted a palpably firm, There is no nipple discharge. There is no axillary
irregular mass in her right breast for the past 3 months. On lymphadenopathy. Mammography reveals a solid 12-cm
physical examination there is no tenderness or swelling. By circumscribed mass. The mass is biopsied, and on
mammography there is an irregular 2 cm density that microscopic examination shows a cellular stromal
contains scattered microcalcifications. Biopsy of this mass component along with an epithelial component. Which of
reveals extensive fat necrosis. Which of the following is the the following is the most likely diagnosis?
most likely cause for this breast lesion? A Fibroadenoma
A Pregnancy B Phyllodes tumor
B Prolactinoma C Sclerosing adenosis
C Trauma D Hamartoma
D Fibrocystic changes E Medullary carcinoma
E Lobular carcinoma in situ (B) CORRECT. Phyllodes tumors are much less common
than fibroadenomas, but they can be quite large. The stromal
F Mastitis component of a phyllodes tumor is more cellular than a
fibroadenoma, and it may show atypia or frank malignancy.
(C) CORRECT. Trauma leads to fat necrosis. This lesion can
sometimes mimic a carcinoma on physical examination and Question 9: A 46-year-old woman has a silicone breast
on the grossly excised breast tissue. implant placed following a left mastectomy for treatment of
an infiltrating ductal carcinoma. She is advised of potential
Question 7: A study of postpartum women is performed. complications, including leakage of the silicone breast
Some of them developed a palpable 'lump' in one or both implant. Which of the following is most likely to be caused by
breasts postpartum. The lump appeared following cessation breast implant leakage?
of breast feeding and persisted for more than one month, A Phyllodes tumor
Many of these lumps regressed following fine needle
aspiration. Which of the following breast lesions is most likely B Scleroderma
to fulfill these criteria? C Breast abscess
A Papilloma D Infiltrating ductal carcinoma
B Fat necrosis E Contracture
C Galactocele
D Ductal epithelial hyperplasia
(E) CORRECT. Pain and contracture with cosmetic deformity
B Plasma cell infiltrate
are the major complications of leaking breast implants.
C Sclerosing adenosis
Question 10: A 52-year-old woman feels a lump in her right
breast on self-examination and goes to her physician. On D Staphylococcus aureus infection
physical examination the 4 cm mass is not freely movable and E Fat necrosis
feels quite hard. A fine needle aspirate is performed and (D) CORRECT. A breast abscess is present. These are most
cytologic examination shows cells are present consistent common in the postpartum period when the nipple becomes
with carcinoma. Which of the following features of this cracked or fissured with nursing.
carcinoma is most likely to suggest a worse prognosis?
A Estrogen receptor positivity Question 13: A 25-year-old woman palpates a left breast
'lump' on self-examination. Her nurse practitioner palpates
B Family history of breast carcinoma an ill-defined mass. There is no pain or tenderness. No
axillary lymphadenopathy is noted. Fine needle aspiration is
C Presence of an in-situ component
performed and cytologic examination shows cells that
D Axillary lymph node metastases appear benign. The lesion persists, and 6 months later
another biopsy is taken and shows ductal epithelial
E Lack of aneuploidy
proliferation with ductal apocrine metaplasia, stromal
(D) CORRECT. Invasion of lymphatics is a poor prognostic
fibrosis, and sclerosing adenosis. Which of the following is
sign, because it suggests that the carcinoma is spreading.
the most likely diagnosis?
Question 11: A 45-year-old woman feels a 'lump' in her left A Infiltrating ductal carcinoma
breast. Her physician palpates a 2 cm irregular area in the
B Ductal carcinoma in situ
upper outer quadrant. A biopsy is performed and
microscopic examination shows no evidence for carcinoma. C Lobular carcinoma in situ
Which of the following microscopic findings in this biopsy is
most likely to suggest an increased risk for subsequent D Fibrocystic changes
development of breast carcinoma? E Intraductal papilloma
A Atypical hyperplasia (D) CORRECT. Fibrocystic changes are very common and
benign, but can produce a mass effect and must be
B Sclerosing adenosis distinguished from breast cancer.
C Apocrine metaplasia
Question 14: A 39-year-old woman has noted red, scaling
D Galactocele area on her breast for 3 months. On physical examination
there is an eczematous 1 cm diameter area on the skin of the
E Multiple cysts
right breast areola. There is no palpable lump in this breast.
(A) CORRECT. Particularly when atypical microscopic features
Biopsy of the skin lesion is performed and on microscopic
are present, lobular or ductal hyperplasia is the component
examination shows large cells at the dermal-epidermal
of fibrocystic disease that is associated with subsequent
junction that stain positively for mucin. Which of the
increased risk for development of carcinoma, probably about
following is the most likely diagnosis?
a 5 fold risk.
A Nipple discharge
Question 12: A 20-year-old woman gives birth to a term girl
B Paget disease of breast
infant following an uncomplicated pregnancy. She breast
feeds the infant. Six weeks later, her left breast becomes C Intraductal carcinoma
painful and slightly swollen. On physical examination there is
a tender 3 cm mass in the left breast beneath a nipple that D Dermatophyte infection
shows several painful fissures. Which of the following E Inflammatory carcinoma
pathologic findings is most likely to be present in this breast?
F Eczematous dermatitis
A Infiltrating ductal carcinoma (B) CORRECT. Paget disease of the breast is a skin lesion that
appears grossly eczematous, but microscopically shows the
presence of malignant cells. There is typically an underlying examination this mass has a lymphoid stroma with little
carcinoma that may be hard to locate. fibrosis surrounding sheets of large vesicular cells with
frequent mitoses. Which of the following is the most likely
Question 15: A 39-year-old woman has noted a bloody nipple diagnosis?
discharge from the right breast for the past 5 weeks. On
A Infiltrating ductal carcinoma
physical examination there is no palpable mass or
tenderness. The skin of this breast shows no lesions. A small B Colloid carcinoma
amount of bloody fluid can be expressed from the right
nipple. Which of the following is the most likely diagnosis? C Medullary carcinoma