Question 1

A 52-year-old woman has felt a lump in her breast for the past 2 months. On physical examination a firm 2 to 3 cm mass is palpable in the upper outer quadrant of her right breast. There are no palpable axillary nodes. A lumpectomy with axillary node dissection is performed. The breast lesion is found to have positive immunohistochemical staining for HER2/neu (c-erb B2). Staining for estrogen and progesterone receptors is negative. Which of the following treatment options is most likely to be efficacious in this woman?

A Letrozole

B Tamoxifen

C Trastuzumab

D Prednisone

E Doxorubicin

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Question 2

A 47-year-old woman undergoes routine mammographic screening and there are multiple small areas of increased density, though a single distinctive mass lesion is not detectable either by palpation or by mammography. A fine needle aspiration biopsy of an abnormal density reveals cells suspicious for a malignancy. An excisional breast biopsy yields a diagnosis of lobular carcinoma in situ of the breast. Which of the following is the most likely finding associated with this woman's carcinoma?

A No residual carcinoma

B Opposite breast involvement

C Absent family history of breast cancer

D Concomitant Paget disease of the nipple

E Negative estrogen receptor assay

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Question 3

A 15-year-old healthy girl of normal height and weight for age is concerned because her right breast has developed to twice the size of her left breast since the onset of puberty at age 12. On physical examination both breasts have a similar consistency on palpation, with no lumps, and there is no tenderness. The nipples and areolae appear normally formed. Which of the following is the most likely cause for these findings?

A Cystosarcoma phyllodes

B Adrenogenital syndrome

C Virginal hypertrophy

D Fibrocystic changes

E Ductal carcinoma in situ

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Question 4

A 20-year-old woman notes a mass in her left breast after following the directions for breast self-examination provided by her health clinic. Her physician palpates a firm, 1 to 2 cm mass. There is no nipple discharge and no pain. No axillary adenopathy is present. The overlying skin of the breast appears normal. Her left breast is slightly larger than the right, a condition she says has been present since puberty. Her urine pregnancy test is negative. Mammography confirms the presence of a rounded density, which has no microcalcifications, and reveals no lesions of the opposite breast. Which of the following is the most likely diagnosis?

A Focus of fat necrosis

B Fibroadenoma

C Intraductal papilloma

D Infiltrating ductal carcinoma

E Phyllodes tumor

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Question 5

A 19-year-old woman gave birth to a healthy male infant at term following an uncomplicated pregnancy. She has now been breast feeding the baby for a month, but notes that her left breast has gradually become swollen and painful to touch over the past week. On physical examination her temperature is 38.2°C. Which of the following is the most likely diagnosis?

A Acute mastitis

B Fibrocystic disease

C Fat necrosis

D Intraductal papilloma

E Galactocele

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Question 6

A 35-year-old woman has noted a palpably firm, irregular mass in her right breast for the past 3 months. On physical examination there is no tenderness or swelling. By mammography there is an irregular 2 cm density that contains scattered microcalcifications. Biopsy of this mass reveals extensive fat necrosis. Which of the following is the most likely cause for this breast lesion?

A Pregnancy

B Prolactinoma

C Trauma

D Fibrocystic changes

E Lobular carcinoma in situ

F Mastitis

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Question 7

A study of postpartum women is performed. Some of them developed a palpable "lump" in one or both breasts postpartum. The lump appeared following cessation of breast feeding and persisted for more than one month, Many of these lumps regressed following fine needle aspiration. Which of the following breast lesions is most likely to fulfill these criteria?

A Papilloma

B Fat necrosis

C Galactocele

D Ductal epithelial hyperplasia

E Sclerosing adenosis

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Question 8

A 49-year-old woman notes increasing size to her right breast over the past year. This breast is not painful, but the heaviness causes some discomfort. On physical examination the overlying skin and nipple appear normal. There is no nipple discharge. There is no axillary lymphadenopathy. Mammography reveals a solid 12-cm circumscribed mass. The mass is biopsied, and on microscopic examination shows a cellular stromal component along with an epithelial component. Which of the following is the most likely diagnosis?

A Fibroadenoma

B Phyllodes tumor

C Sclerosing adenosis

D Hamartoma

E Medullary carcinoma

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Question 9

A 46-year-old woman has a silicone breast implant placed following a left mastectomy for treatment of an infiltrating ductal carcinoma. She is advised of potential complications, including leakage of the silicone breast implant. Which of the following is most likely to be caused by breast implant leakage?

A Phyllodes tumor

B Scleroderma

C Breast abscess

D Infiltrating ductal carcinoma

E Contracture

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Question 10

A 52-year-old woman feels a lump in her right breast on self-examination and goes to her physician. On physical examination the 4 cm mass is not freely movable and feels quite hard. A fine needle aspirate is performed and cytologic examination shows cells are present consistent with carcinoma. Which of the following features of this carcinoma is most likely to suggest a worse prognosis?

A Estrogen receptor positivity

B Family history of breast carcinoma

C Presence of an in-situ component

D Axillary lymph node metastases

E Lack of aneuploidy

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Question 11

A 45-year-old woman feels a "lump" in her left breast. Her physician palpates a 2 cm irregular area in the upper outer quadrant. A biopsy is performed and microscopic examination shows no evidence for carcinoma. Which of the following microscopic findings in this biopsy is most likely to suggest an increased risk for subsequent development of breast carcinoma?

A Atypical hyperplasia

B Sclerosing adenosis

C Apocrine metaplasia

D Galactocele

E Multiple cysts

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Question 12

A 20-year-old woman gives birth to a term girl infant following an uncomplicated pregnancy. She breast feeds the infant. Six weeks later, her left breast becomes painful and slightly swollen. On physical examination there is a tender 3 cm mass in the left breast beneath a nipple that shows several painful fissures. Which of the following pathologic findings is most likely to be present in this breast?

A Infiltrating ductal carcinoma

B Plasma cell infiltrate

C Sclerosing adenosis

D Staphylococcus aureus infection

E Fat necrosis

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Question 13

A 25-year-old woman palpates a left breast "lump" on self-examination. Her nurse practitioner palpates an ill-defined mass. There is no pain or tenderness. No axillary lymphadenopathy is noted. Fine needle aspiration is performed and cytologic examination shows cells that appear benign. The lesion persists, and 6 months later another biopsy is taken and shows ductal epithelial proliferation with ductal apocrine metaplasia, stromal fibrosis, and sclerosing adenosis. Which of the following is the most likely diagnosis?

A Infiltrating ductal carcinoma

B Ductal carcinoma in situ

C Lobular carcinoma in situ

D Fibrocystic changes

E Intraductal papilloma

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Question 14

A 39-year-old woman has noted red, scaling area on her breast for 3 months. On physical examination there is an eczematous 1 cm diameter area on the skin of the right breast areola. There is no palpable lump in this breast. Biopsy of the skin lesion is performed and on microscopic examination shows large cells at the dermal-epidermal junction that stain positively for mucin. Which of the following is the most likely diagnosis?

A Nipple discharge

B Paget disease of breast

C Intraductal carcinoma

D Dermatophyte infection

E Inflammatory carcinoma

F Eczematous dermatitis

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Question 15

A 39-year-old woman has noted a bloody nipple discharge from the right breast for the past 5 weeks. On physical examination there is no palpable mass or tenderness. The skin of this breast shows no lesions. A small amount of bloody fluid can be expressed from the right nipple. Which of the following is the most likely diagnosis?

A Mastitis

B Intraductal papilloma

C Trauma

D Infiltrating ductal carcinoma

E Tuberculosis

F Fibrocystic changes

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Question 16

A 61-year-old woman has noted a rough, reddened appearance increasing in size over the skin of her right breast for the past 5 months. This persists despite application of a corticosteroid cream. On physical examination the skin over the right breast is indurated, roughened, and reddish-orange. There is nipple retraction. A firm, irregular 5 cm mass is palpable in this breast. Which of the following is the most likely risk factor for this woman's condition?

A Cigarette smoking

B Prior fibrocystic disease

C Multiparity

D Family history

E Human papillomavirus infection

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Question 17

A 41-year-old woman has felt a large breast lump that has increased slowly in size for the past 3 years. On physical examination there is a 9 cm firm, movable mass present in her left breast. The overlying skin appears normal; there is no axillary lymphadenopathy. The mass is excised and grossly appears soft and fleshy. On microscopic examination this mass has a lymphoid stroma with little fibrosis surrounding sheets of large vesicular cells with frequent mitoses. Which of the following is the most likely diagnosis?

A Infiltrating ductal carcinoma

B Colloid carcinoma

C Medullary carcinoma

D Lobular carcinoma

E Phyllodes tumor

F Diffuse large B cell lymphoma

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Question 18

A clinical study is performed involving subjects who are women ranging in age from 15 to 45 years who palpated breast "lumps" on self-examination. The presence of breast mass lesions in these subjects was subsequently confirmed by physical examination and by mammography. All subjects had a needle biopsy or excision of their lesion performed, with a definitive pathologic diagnosis made. Which of the following diagnoses is likely to be the most frequently made in these subjects?

A Abscess

B Fibroadenoma

C Fibrocystic changes

D Lobular carcinoma in situ

E Infiltrating ductal carcinoma

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Question 19

A 61-year-old woman has increasing dyspnea with chest pain for the past 4 months. On physical examination there is dullness to percussion over both lungs. A chest x-ray shows bilateral pleural effusions. A thoracentesis yields bloody fluid that cytologically contains small malignant cells forming long rows or rings. A mammogram shows an irregular area of architectural disortion in her left breast. Which of the following histologic types of breast cancer is most likely to be present in this woman?

A Lobular

B Ductal

C Medullary

D Tubular

E Papillary

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Question 20

A 30-year-old woman has felt a mass in her right breast for 6 months. On physical examination there is a 5 cm right breast mass and firm, non-tender lymphadenopathy. A fine needle aspiration is performed and cytologic examination shows carcinoma cells. A right mastectomy with axillary lymph node dissection is performed. Microscopic examination shows a poorly differentiated carcinoma that is negative for estrogen and progesterone receptors and negative for HER2/neu. One axillary lymph node demonstrates micrometastases. Her 32 year old sister is found to have a similar lesion. Which of the following is the most likely risk factor for this woman's breast cancer?

A BRCA1 mutation

B Late menarche

C Positive antinuclear antibody test

D Exposure to hydrocarbon compounds

E Prior fibrocystic changes

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Question 21

A 45-year-old woman has noted a mass in her right breast for 7 months. On physical examination there is a 5 cm diameter right breast mass. A biopsy of the mass is performed and on microscopic examination a carcinoma is present. Which of the following pathologic findings involving this lesion suggests a better prognosis for this woman?

A Estrogen receptor negative

B Axillary lymph node metastasis

C Age at diagnosis

D Aneuploidy by flow cytometry

E Intraductal histologic pattern

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Question 22

A 51-year-old healthy man has noted bilaterally enlarged breasts for the past 35 years. On physical examination his breasts are 3 times normal size, with no masses present, no tenderness, and no axillary lymphadenopathy. Which of the following conditions is most likely to be associated with his breast enlargement?

A Antidepressant drug therapy

B 47, XXY karyotype

C Family history

D Seminoma of the testis

E Increased testosterone levels

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Question 23

A study of breast carcinomas is conducted. Some of these carcinomas are found to be 'triple negative' for estrogen receptor, progesterone receptor, and HER2. Which of the following microscopic findings is most characteristic for these triple negative breast carcinomas?

A Inflammatory component

B Multifocality

C High grade

D Tubular growth pattern

E Desmoplasia

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Question 24

A 49-year-old woman goes to her physician for a routine health maintenance examination. A screening mammogram is performed and shows a 3 cm irregular density in her left breast that has microcalcifications. A needle biopsy of this area shows ducts containing solid sheets of malignant cells, with central necrosis and calcification. There is no invasion. A lumpectomy with wide excision to clear margins is performed along with axillary lymph node sampling that shows no metastases. Malignant cells are positive for HER2 but negative for estrogen receptor. Which of the following is the most likely outcome for this woman?

A Recurrence in the opposite breast

B Cure with no further therapy

C Response to therapy with tamoxifen

D Development of inflammatory carcinoma

E Her children will inherit a BRCA1 mutation

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Question 25

A 69-year-old woman has a screening mammogram that shows an irregular 1 to 2 cm density in her right breast. She has no axillary lymphadenopathy. A needle biopsy is performed and on microscopic examination shows malignant cells floating in mucinous lakes. The nuclei show minimal pleomorphism and no mitoses are seen. The cells are positive for estrogen receptor and negative for HER2 (c-erb B2). A chest x-ray shows no abnormal findings. A bone scan is negative. What is the most likely designation for grade and stage of this neoplasm?

A Grade I, Stage T1 M0 N0

B Grade I, Stage T2 M1 N1

C Grade II, Stage T3 M0 N0

D Grade II, Stage T2 M0 N1

E Grade III, Stage T3 M0 N1

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