Pathology Notes

Practice question Pathology of breast II © Jun Wang, MD, PhD 1. Use this case for the next two questions . A 42-year-old woman presents with a pruritic rash on her left nipple for 2 weeks. She has a history of type 2 diabetes and multiple skin melanomas. Physical examination reveals a 0.3 ulcerated area of the left nipple in a background of eczematous changes. No palpable breast mass or axillary lymphadenopathy is identified. Biopsy of the nipple reveals scattered large atypical cells with pale cytoplasm and enlarged irregular hyperchromic nuclei in the epidermis. Scattered neutrophils and lymphocytes are seen at the dermal epidermal junction. Per immunohistochemistry studies, these large pale cells are positive for cytokeratin, but negative for S-100. Special stain reveals no evidence of fungal hyphae. What is the diagnosis? A. Contact dermatitis B. Dermatophytosis C. Melanoma in situ D. Mycosis fungoides E. Paget’s disease 2. A 42-year-old woman presents w

Practice question answers Pathology of breast II © Jun Wang, MD, PhD 1. E. Paget disease of breast is a malignant tumor confined in epidermis and characterized by clusters of large pale tumor cells in epidermis. They are positive for cytokeratin but negative for S-100, a marker for melanocytic differentiation. Contact dermatitis has inflammatory changes but not pale atypical cells in epidermis. Dermatophytosis usually has neutrophilic infiltrate with positive stains for fungal elements. Mycosis fungoides is a cutaneous T cell lymphoma characterized by large atypical T cell in epidermis. These cells are positive for CD4 but not cytokeratin. 2. D. Paget disease of breast is associated underlying breast cancers. Abnormal insulin activity is seen in diabetes, a risk factor for fungal infection. Allergic reaction is the cause for some contact dermatitis. UV light is associated with many skin cancers, but not Paget disease of breast . 3. B. Dilated ducts filled with monot

Practice question Pathology of breast I © Jun Wang, MD, PhD 1. Use this case for the next three questions . A 22-year-old woman presents with left breast pain for 2 days. She delivered a normal boy 3 months ago and is currently breast feeding him. Her past medical history is unremarkable. Her mother was diagnosed with invasive ductal carcinoma at age of 49. Physical examination reveals a tender left breast with erythematous and edematous changes at inner lower quadrant. No discrete mass is noted. A small crack is seen at her left nipple. A few small left axillary lymph nodes are noted. Laboratory tests and radiologic examinations are unremarkable. What are the most likely pathological findings if biopsy is performed? A. Atypical cells forming single files B. Calcifications C. Diffuse infiltrate of neutrophils D. Finger likely projects covered by normal appearing epithelium E. Irregular glands infiltrating stroma 2. A 22-year-old woman presents with left breast

Practice question answers Pathology of breast I © Jun Wang, MD, PhD 1. C. The clinical presentations of pain, erythematous and edematous changes are supportive of inflammatory process. Although she has a family history of cancer, no other evidence of neoplasm is noted. The post-partum status and presence of nipple crackers are more commonly associated with acute mastitis . The axillary lymphadenopathy is most likely reactive. The most characteristic pathological findings of any acute inflammation is diffuse neutrophilic infiltrate. Atypical cell forming single files are seen in invasive lobular carcinoma . Calcifications are nonspecific degenerative changes that can be seen in fibrocystic changes , inflammations, and carcinomas . Finger like projects with normal appearing cells are seen in benign papillary lesions, including usual ductal hyperplasia and intraductal papilloma . Irregular glands infiltrating stroma is characteristic for adenocarcinoma, including invasive carcin