Which of the following is the most likely diagnosis in this patient? - ProProfs Discuss
Topics
Products
Follow Us:

Which of the following is the most likely diagnosis in this patient?
A 39-year-old Caucasian female presents to your office with a palpable nodularity in the right breast. Pathologically, the lesion is composed of ducts distended by pleomorphic cells with prominent central necrosis. The lesion does not extend beyond the ductal basal membrane.



A. Paget disease
B. Comedocarcinoma
C. Medullary carcinoma
D. Sclerosing adenosis
E. Mammary duct ectasia

This question is part of

USMLE STEP 1 PATHOPHYSIOLOGY BLOCK 7
Asked by Melbourne, Last updated: Mar 29, 2020

+ Answer
Request

2 Answers

Chris Kenway

Chris Kenway, Content Writer, Jacksonville

Answered Feb 13, 2019

The correct answer to this question is B. The typical histological picture of comedocarcinoma (DCIS) is described. Ductal carcinoma in situ (DCIS) is a precancerous breast lesion characterized by a malignant clonal cell proliferation contained by the surrounding ductal basement membrane. The (basal) myoepithelial layer of the duct is preserved and uninvolved. Usually only a single ductal system appears to have DCIS. However, far more extensive DCIS lesions can occur, with widespread involvement of the breast parenchyma occasionally identified.

In mammographically screened populations, DCIS now represents 15-30% of all carcinomas and 50% of mammogram-identified carcinomas. Classically, DCIS is divided into five different subtypes: comedocarcinoma, solid, cribriform, papillary, and micropapillary. Most cases have a mixture of patterns.

Comedocarcinoma, as seen in this patient, is identified as solid sheets of pleomorphic, high-grade cells with central necrosis. Chronic inflammation and periductal concentric fibrosis are additional findings.

As the malignant cell membranes become necrotic they calcify, allowing mammographic detection of microcalcification clusters. If the comedocarcinoma is extensive, the lesion maybe palpable as a poorly defined nodule.

 

John Smith

John Smith

Answered Sep 08, 2016

Comedocarcinoma-the typical histological picture of comedocarcinoma (dcis) is described. ductal carcinoma in situ (dcis) is a precancerous breast lesion characterized by a malignant clonal cell proliferation contained by the surrounding ductal basement membrane. the (basal) myoepithelial layer of the duct is preserved and uninvolved. usually only a single ductal system appears to have dcis. however, far more extensive dcis lesions can occur, with widespread involvement of the breast parenchyma occasionally identified. in mammographically screened populations, dcis now represents 15-30% of all carcinomas and 50% of mammogram-identified carcinomas. classically, dcis is divided into five different subtypes: comedocarcinoma, solid, cribriform, papillary, and micropapillary. most cases have a mixture of patterns. comedocarcinoma, as seen in this patient, is identified as solid sheets of pleomorphic, high-grade cells with central necrosis. chronic inflammation and periductal concentric fibrosis are additional findings. as the malignant cell membranes become necrotic they calcify, allowing mammographic detection of mi crocalcifi cation clusters. if the comedocarcinoma is extensive, the lesion maybe palpable as a poorly defined nodule.
 

Search for Google images
Select a recommended image
Upload from your computer
Search for Google images
Select a recommended image
Upload from your computer
Search for Google images
Select a recommended image
Upload from your computer

Email Sent
We have sent an email to your address "" with instructions to reset your password.