a = new Array(129);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. A radical procedure is not indicated with a cancer that has a lower stage."
a[2] = f + "(B) Incorrect. Tamoxifen is most useful with estrogen receptor positive carcinomas of the breast."
a[3] = f + "(C) CORRECT. This is an infiltrating ductal carcinoma. The lack of ER staining suggests a poor response to hormonal therapy with tamoxifen. The positive C-erb B2 (HER2/neu) staining suggests that the monoclonal antibody traztuzumab may be effective. Radical mastectomies are rarely performed."
a[4] = f + "(D) Incorrect. Alternative medical therapies may not have the toxicity of chemotherapy, but are unlikely to modify the biologic behavior of a neoplasm."
a[5] = f + "(E) Incorrect. Antibiotic therapy is not going to be effective against a neoplasm."
a[6] = f + "(A) Incorrect. The opposite breast may also be involved."
a[7] = f + "(B) CORRECT. Bilaterality is a frequent characteristic of lobular carcinoma in situ."
a[8] = f + "(C) Incorrect. Breast cancer is more likely with a family history."
a[9] = f + "(D) Incorrect. Paget disease of the nipple is most often associated with an underlying ductal carcinoma."
a[10] = f + "(E) Incorrect. Most breast cancers are estrogen receptor positive, particularly the better differentiated and in situ carcinomas."
a[11] = f + "(A) Incorrect. This is a large bulky tumor that typically does not appear in persons this young."
a[12] = f + "(B) Incorrect. It would be unusual to have an ovarian tumor at this age. Any syndromes of hormone excess from any source would affect both breasts."
a[13] = f + "(C) CORRECT. This is a problem that can be easily remedied with plastic surgery."
a[14] = f + "(D) Incorrect. Fibrocystic changes are usually seen later and produce palpable breast 'lumps' but not significant breast enlargement."
a[15] = f + "(E) Incorrect. Breast carcinomas are uncommon below age 25 and do not typically produce significant breast enlargement."
a[16] = f + "(A) Incorrect. These lesions, though producing a mass lesion, are not discrete, and may mimic carcinoma."
a[17] = f + "(B) CORRECT. At her age, such a firm small mass is most likely to be a benign lesion, and a fibroadenoma is the most likely cause for this small 'lump' in the breast. Cancers are not common at this age."
a[18] = f + "(C) Incorrect. These lesions are not common. They tend to be subareolar and tend to be associated with bloody nipple discharge."
a[19] = f + "(D) Incorrect. A carcinoma would not be expected to be discrete, and age 25 is quite young for carcinoma."
a[20] = f + "(E) Incorrect. A cystosarcoma phyllodes is typically a large mass."
a[21] = f + "(A) CORRECT. The organism is most often <I>Staphylococcus aureus</I> or <I>Streptococcus</I>. Antibiotic therapy is usually successful."
a[22] = f + "(B) Incorrect. Fibrocystic changes lead to breast lumps but not to acute inflammation."
a[23] = f + "(C) Incorrect. Fat necrosis is typically the result of trauma and may produce a palpable mass lesion, but not acute inflammatory changes."
a[24] = f + "(D) Incorrect. An intraductal papilloma may produce a bloody nipple discharge, but not acute inflammation."
a[25] = f + "(E) Incorrect. A galactocele could arise with lactation, but acute inflammation is not part of the picture."
a[26] = f + "(A) Incorrect. Pregnancy is associated with lactational changes, but fat necrosis is not part of this process."
a[27] = f + "(B) Incorrect. Galactorrhea may complicate a pituitary adenoma secreting prolactin."
a[28] = f + "(C) CORRECT. Trauma leads to fat necrosis. This lesion can sometimes mimic a carcinoma on physical examination and grossly."
a[29] = f + "(D) Incorrect. Fibrocystic changes may include cysts, duct enlargement, and fibrous thickening, but necrosis is not part of this process."
a[30] = f + "(E) Incorrect. LCIS is typically not palpable, because the foci are small, and necrosis is typically not part of the process."
a[30.1] = f + "(F) Incorrect. Mastitis is more likely to present as a more diffuse process, associated with pain and tenderness. Often mastitis is associated with breast feeding."
a[31] = f + "(A) Incorrect. This occurs in the setting of lactation, but not oral contraceptive use."
a[32] = f + "(B) Incorrect. Fat necrosis is produced by trauma."
a[33] = f + "(C) CORRECT. Galactocele occurs secondary to obstruction of lactiferous ducts. It is a non-neoplastic process."
a[34] = f + "(D) Incorrect. Hypertrophy is a function of breast sensitivity to hormonal stimulation."
a[35] = f + "(E) Incorrect. Cysts are seen most often in association with fibrocystic changes of the breast."
a[36] = f + "(A) Incorrect. Fibroadenomas are usually small."
a[37] = f + "(B) CORRECT. These tumors can be quite large. The stromal component is more cellular than a fibroadenoma and may show atypia or frank malignancy."
a[38] = f + "(C) Incorrect. This is part of fibrocystic changes and does not form a mass."
a[39] = f + "(D) Incorrect. Such a lesion is quite rare in the breast."
a[40] = f + "(E) Incorrect. These can be bulky tumors, but there is no stromal component."
a[41] = f + "(A) Incorrect. This is a rare tumor and is not associated with breast implants."
a[42] = f + "(B) Incorrect. This is controversial, but there is no convincing evidence that immunologic disease results from breast implants."
a[43] = f + "(C) Incorrect. The implant within the breast is unlikely to become infected, ruptured or not."
a[44] = f + "(D) Incorrect. Women with breast implants actually have a lower rate of carcinoma of the breast. In women who have had breast cancer, the risk of recurrence is not increased."
a[45] = f + "(E) CORRECT. Pain and contracture with cosmetic deformity are the major complications of leaking breast implants."
a[46] = f + "(A) Incorrect. An ER postitive tumor has a better prognosis because it will respond to certain therapies."
a[47] = f + "(B) Incorrect. A family history makes breast cancer more likely, but does not predict prognosis."
a[48] = f + "(C) Incorrect. In situ lesions are the lowest stage possible for a carcinoma."
a[49] = f + "(D) CORRECT. Invasion of lymphatics is a poor prognostic sign, because it suggests that the carcinoma is spreading."
a[50] = f + "(E) Incorrect. Aneuploidy diagnosed with flow cytometry suggests a worse prognosis."
a[51] = f + "(A) CORRECT. Particularly when atypical microscopic features are present, lobular or ductal hyperplasia is the component of fibrocystic disease that is associated with subsequent increased risk for development of carcinoma."
a[52] = f + "(B) Incorrect. This component of fibrocystic disease does not imply an increased risk for breast cancer."
a[53] = f + "(C) Incorrect. This lesion may sometimes be difficult to distinguish grossly from carcinoma, but it does not predispose to carcinoma."
a[54] = f + "(D) Incorrect. This is a complication of obstruction to lactiferous sinuses during lactation. It may rarely occur with oral contraceptive use. It is not premalignant."
a[55] = f + "(E) Incorrect. Simple cysts with fibrocystic disease are not associated with an increased risk for carcinoma."
a[56] = f + "(A) Incorrect. Ductal carcinomas are ill-defined masses that are usually not tender. They are extremely rare before age 25."
a[57] = f + "(B) Incorrect. A 'plasma cell mastitis' is the result of inspissated duct secretions and is most often seen in women in their 40's and 50's."
a[58] = f + "(C) Incorrect. This is a part of fibrocystic disease, which may have a cystic mass that may be tender, but not nipple fissuring."
a[59] = f + "(D) CORRECT. A breast abscess is present. These are most common in the postpartum period when the nipple becomes cracked or fissured with nursing."
a[60] = f + "(E) Incorrect. This lesion is usually due to trauma and leads to an ill-defined mass."
a[61] = f + "(A) Incorrect. Fat necrosis, often following trauma, can produce a focal lesion that on palpation and grossly mimics a carcinoma. Microscopically there are abundant macrophages."
a[62] = f + "(B) Incorrect. Ductal carcinoma in situ is marked by highly atypical, disorganized cells within ductal lumens."
a[63] = f + "(C) Incorrect. Lobular carcinoma in situ is marked by highly atypical cells filling and expanding lobules."
a[64] = f + "(D) CORRECT. Fibrocystic changes are very common and benign, but can produce a mass effect and must be distinguished from breast cancer."
a[65] = f + "(E) Incorrect. An intraductal papilloma is a focal lesion with both epithelial and stromal proliferation in a papillary pattern."
a[66] = f + "(A) Incorrect. Discharges are more likely with intraductal papillomas, and they do not lead to the appearance of malignant cells at the dermal-epidermal junction."
a[67] = f + "(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 carcinoma that may be hard to locate."
a[68] = f + "(C) Incorrect. Such a lesion should be within the breast and not involve overlying skin."
a[69] = f + "(D) Incorrect. Skin infections may produce erythematous lesions, but without malignant cells present."
a[70] = f + "(E) Incorrect. An 'inflammatory carcinoma' is not a histologic type of breast cancer, but a term that describes dermal lymphatic involvement by breast cancer. In this case, the malignant cells are not in lymphatics."
a[70.1] = f + "(F) Incorrect. A rough, red, scaling patch of skin can be termed eczema, but should not contain malignant cells staining for mucin."
a[71] = f + "(A) Incorrect. The inflammation with mastitis does not usually erode breast tissue and cause bleeding."
a[72] = f + "(B) CORRECT. This solitary lesion of a lactiferous sinus is not common, but you should suspect it when there is a bloody discharge. This lesion is not premalignant."
a[73] = f + "(C) Incorrect. Fat necrosis leads to scarring and hemorrhage is not common (at least, hemorrhage into the lactiferous sinuses is not common)."
a[74] = f + "(D) Incorrect. The slowly infiltrative growth of ductal cancers leads to scarring, not hemorrhage."
a[75] = f + "(E) Incorrect. Mycobacterial infections involving the breast are quite rare."
a[75.1] = f + "(F) Incorrect. Fibrocystic changes are not likely to be accompanied by hemorrhage."
a[76] = f + "(A) Incorrect. Smoking increases the risk for lung cancers, urinary tract cancers, and pancreatic carcinomas. However, there is no link to breast cancers."
a[77] = f + "(B) Incorrect. Fibrocystic changes in the breast are not a significant risk factor for subsequent development of breast cancer, unless there is some epithelial atypia present."
a[78] = f + "(C) Incorrect. Multiparity tends to reduce the overall risk for breast cancer."
a[79] = f + "(D) CORRECT. A The findings point to breast carcinoma with invasion of the overlying skin ('inflammatory carcinoma'). A family history of breast cancer increases the risk for breast cancer the most."
a[80] = f + "(E) Incorrect. HPV infections increase the risk for squamous epithelial dysplasias and carcinomas in the female genital tract, not the breast."
a[81] = f + "(A) Incorrect. A ductal carcinoma is unlikely to reach this size, and it does not have a lymphoid stroma. It often has pronounced desmoplasia."
a[82] = f + "(B) Incorrect. This is a reddish, eczematous lesion of the overlying skin that microscopically consists of adenocarcinoma cells infiltrating the epidermis."
a[83] = f + "(C) CORRECT. Medullary carcinoma is often bulky, with pushing margins. It lacks the desmoplasia typical of ductal carcinomas. It accounts for only about 1% of breast cancers."
a[84] = f + "(D) Incorrect. This cancer does not form a large mass and is poorly circumscribed. It is bilateral about 20% of the time. It makes up only 5 to 10% of breast cancers."
a[85] = f + "(E) Incorrect. This tumor can become quite large, but is composed of both epithelial and stromal components, either or both of which may be malignant."
a[85.1] = f + "(F) Incorrect. Non-Hodgkin lymphoma involving the breast is not common. Lymphomas do not have a malignant epithelial component."
a[86] = f + "(A) Incorrect. Abscesses are uncommon, though some may arise as complications in women who nurse their babies and develop fissures in the nipple."
a[87] = f + "(B) Incorrect. These represent about 1 in 13 lumps, but they are more prominent in younger women of reproductive years."
a[88] = f + "(C) CORRECT. About 40% of breast lumps turn out to be caused by fibrocystic changes."
a[89] = f + "(D) Incorrect. Lobular CIS is uncommon."
a[90] = f + "(E) Incorrect. Overall, carcinomas represent about 10% of breast lumps, but it is very important to find them."
a[91] = f + "(A) CORRECT. Increased cellularity is typical for a phyllodes tumor. The greater the degree of anaplasia and number of mitoses, the more likely that the phyllodes tumor is malignant."
a[92] = f + "(B) Incorrect. In general, phyllodes tumors are larger, but some fibroadenomas can reach a large size, so-called 'giant fibroadenomas'."
a[93] = f + "(C) Incorrect. This is not the best distinguishing feature."
a[94] = f + "(D) Incorrect. Location plays no role in differentiation, and when either tumor is large, it will appear to fill the whole breast."
a[95] = f + "(E) Incorrect. Either tumor will appear as a mass lesion."
a[96] = f + "(A) CORRECT. A small number of breast cancers are the result of an inherited BRCA-1 mutation (or BRCA-2), but the family history of breast cancer at a young age makes this more likely."
a[97] = f + "(B) Incorrect. Early menarche and late menopause and nulliparity are risks for breast cancer."
a[98] = f + "(C) Incorrect. Autoimmune diseases do not appreciably increase the risk for breast cancer."
a[99] = f + "(D) Incorrect. Breast cancers are not typically thought to be related to environmental exposures."
a[100] = f + "(E) Incorrect. Fibrocystic changes do not substantially increase the risk for breast cancer. Atypical epithelial hyperplasia would increase the risk."
a[101] = f + "(A) Incorrect. The presence of estrogen receptors suggests better differentiation and better response to hormonal manipulation."
a[102] = f + "(B) Incorrect. Axillary lymph node metastasis is the single most important prognostic factor for patients with early breast carcinoma. Metastases imply a worse prognosis."
a[103] = f + "(C) Incorrect. Stage I breast carcinoma includes cases in which the mass is less than 5 cm and there are no metastases."
a[104] = f + "(D) Incorrect. Aneuploidy suggests a more aggressive neoplasm and a worse prognosis."
a[105] = f + "(E) CORRECT. The best overall survival is with intraductal carcinomas (those that have not invaded out from the ducts); this is the lowest stage possible."
a[106] = f + "(A) Incorrect. Chronic alcoholism may lead to gynecomastia. Digoxin therapy may have this complication."
a[107] = f + "(B) CORRECT. Gynecomastia is common with Klinefelter syndrome."
a[108] = f + "(C) Incorrect. He has a benign process. Male breast carcinomas can be associated with BRCA mutations. They are rare and more often associated with advanced age."
a[109] = f + "(D) Incorrect. There is an association between gynecomastia and some functioning testicular tumors such as Leydig cell tumors (or rarely, Sertoli cell tumors)."
a[110] = f + "(E) Incorrect. Gynecomastia is related to hyperestrinism, and one of the most common causes for this is cirrhosis of the liver in chronic alcoholics."
a[111] = f + "(A) Incorrect. The nodule is most likely benign, whereas the enlarged lymph nodes are most likely to accompany a breast cancer with metastases."
a[112] = f + "(B) Incorrect. Gynecomastia in a boy or young male is often idiopathic and does not produce a mass lesion."
a[113] = f + "(C) CORRECT. A fibroadenoma of the breast is typically found incidentally on palpation, though sometimes they may enlarge slightly and cause some discomfort in association with menstruation."
a[114] = f + "(D) Incorrect. A bloody nipple discharge is most often associated with an intraductal papilloma of breast."
a[115] = f + "(E) Incorrect. Precocious puberty can lead to early breast development, but not mass lesions."
a[116] = f + "(A) Incorrect. Appearance in the opposite breast is a feature of lobular carcinomas."
a[117] = f + "(B) CORRECT. She has a ductal carcinoma in situ (DCIS). Since it is non-invasive at the time of diagnosis, it has a good prognosis. Some will recur locally. If left alone, DCIS will often progress to become an invasive carcinoma."
a[118] = f + "(C) Incorrect. The lack of estrogen receptor positivity in the tumor cells predicts a poor response to hormonal therapy with tamoxifen."
a[119] = f + "(D) Incorrect. Spread via lymphatics to the skin overlying the breast is not likely, since this is an in situ carcinoma."
a[120] = f + "(E) Incorrect. At her age, this is less likely to be a cancer associated with BRCA-1 or BRCA-2 than in a younger woman. Only a small number of all breast cancers are associated with known mutations."
a[121] = f + "(A) CORRECT. The histologic features are those of a low grade colloid carcinoma, a histologic type that typically is ER positive, without metastases, and with a good prognosis. The stage is low because there is a small tumor without evidence of either nodal or distant metastases."
a[122] = f + "(B) Incorrect. No evidence for nodal metastases is present; the tumor size is small."
a[123] = f + "(C) Incorrect. The tumor is a low grade, and the size is small."
a[124] = f + "(D) Incorrect. The tumor is a low grade, and the size is small; no evidence for nodal metastases is present."
a[125] = f + "(E) Incorrect. The tumor is a low grade, and the size is small; no evidence for nodal metastases is present."