Ans:A This irregular,infiltrative mass is an infiltrating ductal carcinoma.the most common form of breast cancer. Breast carcinomas are most likely to metastasize to regional lymph nodes.By the time a breast cancer becomes palpable,lymph node metastasis are present in more than 50%of patients.A bloody discharge from the nipple most often results from an intraductal papilloma.Breast cancers are associated in rare cases with ectopic corticotropin secretion or Cushing syndrome.Lobular carcinomas are more often bilateral,but they are less common than infiltrating ductal carcinomas.Pain with breast enlargement suggests inflammation. 5.A 47-year-old woman has noticed a red,scaly area of skin on her left breast that has grown slightly larger over the past 4 months.On physical examination,there is a 1-cm area of eczematous skin just lateral to the earance of the skin biopsy specimen is shown above.Which of the following is the metaplasia E.Paget disease of the breast Ans:E Paget cells are large cells that have clear mucinous cytoplasm and infiltrate the skin.They are malignant and extend to the skin from an underlying breast carcinoma.Apocrine metaplasia affects cells lining the cystically dilated ducts in fibrocystic change.The macrophages in fat necrosis do not infiltrate the skin and do not have the atypical nuclei seen in the figure."Inflammatory carcinoma"does not refer to a specific histologic type of breast cancer;rather it describes the involvement of dermal lymphatics by infiltrating carcinoma.In lobular carcinoma in situ,terminal ducts or acini are filled with neoplastic cells.The overlying skin is unaffected. 6.A 24-year-old woman experiences sudden onset of severe lower abdominal pain.Physical examination shows no masses,but there is severe tenderness in the right lower quadrant.A pelvice examination shows no lesions of the cervix or va vel sounds are detected.An abdominal ultr d shows a 4-cm focal enlar the cht fallop A dilatio dure A.Molar pregnancyD. Mass in the opposite breast E. Painful breast enlargement Ans: A This irregular, infiltrative mass is an infiltrating ductal carcinoma, the most common form of breast cancer. Breast carcinomas are most likely to metastasize to regional lymph nodes. By the time a breast cancer becomes palpable, lymph node metastasis are present in more than 50% of patients. A bloody discharge from the nipple most often results from an intraductal papilloma. Breast cancers are associated in rare cases with ectopic corticotropin secretion or Cushing syndrome. Lobular carcinomas are more often bilateral, but they are less common than infiltrating ductal carcinomas. Pain with breast enlargement suggests inflammation. 5. A 47-year-old woman has noticed a red, scaly area of skin on her left breast that has grown slightly larger over the past 4 months. On physical examination, there is a 1-cm area of eczematous skin just lateral to the areola. The microscopic appearance of the skin biopsy specimen is shown above. Which of the following is the MOST LIKELY diagnosis? A. Apocrine metaplasia B. Fat necrosis C. Inflammatory carcinoma D. Lobular carcinoma in situ E. Paget disease of the breast Ans: E Paget cells are large cells that have clear mucinous cytoplasm and infiltrate the skin. They are malignant and extend to the skin from an underlying breast carcinoma. Apocrine metaplasia affects cells lining the cystically dilated ducts in fibrocystic change. The macrophages in fat necrosis do not infiltrate the skin and do not have the atypical nuclei seen in the figure. “Inflammatory carcinoma” does not refer to a specific histologic type of breast cancer; rather it describes the involvement of dermal lymphatics by infiltrating carcinoma. In lobular carcinoma in situ, terminal ducts or acini are filled with neoplastic cells. The overlying skin is unaffected. 6. A 24-year-old woman experiences sudden onset of severe lower abdominal pain. Physical examination shows no masses, but there is severe tenderness in the right lower quadrant. A pelvic examination shows no lesions of the cervix or vagina. Bowel sounds are detected. An abdominal ultrasound shows a 4-cm focal enlargement of the proximal right fallopian tube. A dilation and curettage procedure shows only decidua from the endometrial cavity. Which of the following is the MOST LIKELY diagnosis? A. Molar pregnancy