Pathoma Exam Questions and Answers 100% Solved
Trauma related breast mass that appears as an abnormal calcification on mammography:
Correct Ans-Fat Necrosis of breast fat with calcification due to saponification. Biopsy
shows necrotic fat with associated calcifications and giant cells.
Most common change in *pre-menopausal* breast that is thought to be hormone mediated.
Presents as vague irregularity of the breast tissue (i.e. lumpy breast): Correct Ans-
Fibrocystic Change -- development of fibrosis and cysts in the breast, usually in the UOQ. Cysts
have blue-dome appearance on gross exam.
While most fibrocystic change of the breast is benign, some changes are associated with an
increased risk for invasive carcinoma in both breasts. Outline the relative risks for (1) Fibrosis,
cysts, and apocrine metaplasia; (2) Ductal hyperplasia and sclerosing adenosis; (3) Atypical
hyperplasia Correct Ans-1. Fibrosis, cysts, and apocrine metaplasia -- no increased risk;
2. Ductal hyperplasia and sclerosing adenosis -- 2X increased risk;
3. Atypical hyperplasia -- 5X increased risk;
Classically presents as bloody nipple discharge in a pre-menopausal women. Must be
distinguished from papillary carcinoma. Correct Ans-*Intraductal Papilloma* -- papillary
growth, usually into a large duct that is characterized by fibrovascular protections lined by
epithelial (luminal) and myoepithelial cells.
How can you distinguish papillary carcinoma from intraductal papilloma? Correct Ans-
Papillary carcinoma is characterized by fibrovascular projections line by epithelial cells
, Pathoma Exam Questions and Answers 100% Solved
without underlying myoepithelial cells. Risk of papillary carcinoma increases with age, thus it
is seen more in post menopausal women.
Most common benign neoplasm of the breast usually seen in premenopausal women that
presents as a well-circumscribed, mobile marble-like mass: Correct Ans-*Fibroadenoma* --
tumor of fibrous tissue and glands that is benign with no increased risk of carcinoma. It is
*estrogen sensitive* -- growing during pregnancy and can cause pane during the menstrual
cycle.
Fibroadenoma-like tumor with overgrowth of the fibrous component with characteristic "leaf-
like" projections seen on biopsy: Correct Ans-*Phyllodes Tumor* -- most commonly seen in
post-menopausal women. Can be malignant in some cases.
Most common carcinoma in women by incidence (excluding skin cancer): Correct Ans-
Breast cancer -- 2nd most common cause of cancer mortality in women.
What are the risk factors for breast cancer? Correct Ans-Risk factors are mostly related to
estrogen exposure:
1. Female gender;
2. Age (post-menopausal women, except hereditary breast cancer);
3. Early menarche/late menopause;
4. Obesity (estrone);
5. Atypical hyperplasia;
6. 1st degree relative (mother, sister, or daughter) with breast cancer;
, Pathoma Exam Questions and Answers 100% Solved
Malignant proliferation of cells in ducts with no invasion of the basement membrane that is
often detected as calcification on mammography: Correct Ans-*Ductal Carcinoma In Situ
(DCIS)* -- though mammographic calcifications can be associated with benign conditions such
as fibrocystic changes (sclerosing adenosis) and fat necrosis. *Biopsy of calcifications is often
necessary to distinguish between benign and malignant conditions*
Subtype of Ductal Carcinoma In Situ that is characterized by high grade cells with necrosis and
dystrophic calcification in the center of ducts: Correct Ans-Comedo Type of DCIS
Subtype of DCIS that extends up the ducts to involve the skin of nipple, presenting as nipple
ulceration and edema: Correct Ans-Paget Disease of the Breast
Nipple ulceration and erythema almost always associated with an underlying carcinoma:
Correct Ans-Paget's Disease of the breast;
What is the functional unit of the breast? Correct Ans-Terminal Duct lobular unit -- the
lobules make milk that drains via ducts to the nipple.
Breast tissue is essentially modified sweat glands embryonically derived from the skin.
Explain how you can have extra nipples or breast tissue: Correct Ans-Breast tissue can
develop anywhere along the *milk line*, which runs from the axilla to the vulva
, Pathoma Exam Questions and Answers 100% Solved
The lobules and ducts are lined by two layers of epithelium -- what are they and what are
their functions? Correct Ans-1. Luminal cell layer -- inner cell layer responsible for milk
production in the lobules;
2. Myoepithelial cell layer -- outer cell layer with contractile function that propels milk
towards the nipple.
Breast tissue is hormone sensitive. Describe the breast (1) prior to puberty and how it
changes (2) following puberty, during (3) menstruation and (4) pregnancy, and (5)after
menopause: Correct Ans-1. Before Puberty -- M and F breast tissue primarily consists of
large ducts under the nipple;
2. Development after menarche is driven by estrogen and progesterone -- lobules and ducts
form, esp. in UOQ;
3. Breast tenderness during menstrual cycle, esp. prior to menstruation;
4. Breast lobules undergo hyperplasia during pregnancy (due to E and P produced by corpus
luteum, fetus, and placenta);
5. After menopause, breast tissue undergoes atrophy;
Trauma related breast mass that appears as an abnormal calcification on mammography:
Correct Ans-Fat Necrosis of breast fat with calcification due to saponification. Biopsy
shows necrotic fat with associated calcifications and giant cells.
Most common change in *pre-menopausal* breast that is thought to be hormone mediated.
Presents as vague irregularity of the breast tissue (i.e. lumpy breast): Correct Ans-
Fibrocystic Change -- development of fibrosis and cysts in the breast, usually in the UOQ. Cysts
have blue-dome appearance on gross exam.
While most fibrocystic change of the breast is benign, some changes are associated with an
increased risk for invasive carcinoma in both breasts. Outline the relative risks for (1) Fibrosis,
cysts, and apocrine metaplasia; (2) Ductal hyperplasia and sclerosing adenosis; (3) Atypical
hyperplasia Correct Ans-1. Fibrosis, cysts, and apocrine metaplasia -- no increased risk;
2. Ductal hyperplasia and sclerosing adenosis -- 2X increased risk;
3. Atypical hyperplasia -- 5X increased risk;
Classically presents as bloody nipple discharge in a pre-menopausal women. Must be
distinguished from papillary carcinoma. Correct Ans-*Intraductal Papilloma* -- papillary
growth, usually into a large duct that is characterized by fibrovascular protections lined by
epithelial (luminal) and myoepithelial cells.
How can you distinguish papillary carcinoma from intraductal papilloma? Correct Ans-
Papillary carcinoma is characterized by fibrovascular projections line by epithelial cells
, Pathoma Exam Questions and Answers 100% Solved
without underlying myoepithelial cells. Risk of papillary carcinoma increases with age, thus it
is seen more in post menopausal women.
Most common benign neoplasm of the breast usually seen in premenopausal women that
presents as a well-circumscribed, mobile marble-like mass: Correct Ans-*Fibroadenoma* --
tumor of fibrous tissue and glands that is benign with no increased risk of carcinoma. It is
*estrogen sensitive* -- growing during pregnancy and can cause pane during the menstrual
cycle.
Fibroadenoma-like tumor with overgrowth of the fibrous component with characteristic "leaf-
like" projections seen on biopsy: Correct Ans-*Phyllodes Tumor* -- most commonly seen in
post-menopausal women. Can be malignant in some cases.
Most common carcinoma in women by incidence (excluding skin cancer): Correct Ans-
Breast cancer -- 2nd most common cause of cancer mortality in women.
What are the risk factors for breast cancer? Correct Ans-Risk factors are mostly related to
estrogen exposure:
1. Female gender;
2. Age (post-menopausal women, except hereditary breast cancer);
3. Early menarche/late menopause;
4. Obesity (estrone);
5. Atypical hyperplasia;
6. 1st degree relative (mother, sister, or daughter) with breast cancer;
, Pathoma Exam Questions and Answers 100% Solved
Malignant proliferation of cells in ducts with no invasion of the basement membrane that is
often detected as calcification on mammography: Correct Ans-*Ductal Carcinoma In Situ
(DCIS)* -- though mammographic calcifications can be associated with benign conditions such
as fibrocystic changes (sclerosing adenosis) and fat necrosis. *Biopsy of calcifications is often
necessary to distinguish between benign and malignant conditions*
Subtype of Ductal Carcinoma In Situ that is characterized by high grade cells with necrosis and
dystrophic calcification in the center of ducts: Correct Ans-Comedo Type of DCIS
Subtype of DCIS that extends up the ducts to involve the skin of nipple, presenting as nipple
ulceration and edema: Correct Ans-Paget Disease of the Breast
Nipple ulceration and erythema almost always associated with an underlying carcinoma:
Correct Ans-Paget's Disease of the breast;
What is the functional unit of the breast? Correct Ans-Terminal Duct lobular unit -- the
lobules make milk that drains via ducts to the nipple.
Breast tissue is essentially modified sweat glands embryonically derived from the skin.
Explain how you can have extra nipples or breast tissue: Correct Ans-Breast tissue can
develop anywhere along the *milk line*, which runs from the axilla to the vulva
, Pathoma Exam Questions and Answers 100% Solved
The lobules and ducts are lined by two layers of epithelium -- what are they and what are
their functions? Correct Ans-1. Luminal cell layer -- inner cell layer responsible for milk
production in the lobules;
2. Myoepithelial cell layer -- outer cell layer with contractile function that propels milk
towards the nipple.
Breast tissue is hormone sensitive. Describe the breast (1) prior to puberty and how it
changes (2) following puberty, during (3) menstruation and (4) pregnancy, and (5)after
menopause: Correct Ans-1. Before Puberty -- M and F breast tissue primarily consists of
large ducts under the nipple;
2. Development after menarche is driven by estrogen and progesterone -- lobules and ducts
form, esp. in UOQ;
3. Breast tenderness during menstrual cycle, esp. prior to menstruation;
4. Breast lobules undergo hyperplasia during pregnancy (due to E and P produced by corpus
luteum, fetus, and placenta);
5. After menopause, breast tissue undergoes atrophy;
