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Old 10-06-2012
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Arrow Billy Step 1 Questions #10

A 39-year-old woman has noticed an enlarging mass in her left breast for the past 2 years. The physician palpates a 4-
cm firm mass. A simple mastectomy is performed with axillary lymph node sampling and plastic reconstruction of the
breast. On gross sectioning, the mass has a soft, tan, fleshy surface. Histologically, the mass is composed of large cells
with vesicular nuclei and prominent nucleoli. There is a marked lymphocytic infiltrate within the tumor, and the tumor has a
discrete, noninfiltrative border. No axillary node metastases are present. The tumor cells are negative for estrogen
receptor and progesterone receptor. What is the most likely diagnosis?


□ (A) Colloid carcinoma
□ (B) Fibroadenoma
□ (C) Infiltrating ductal carcinoma
□ (D) Infiltrating lobular carcinoma
□ (E) Intraductal papilloma
□ (F) Medullary carcinoma
□ (G) Papillary carcinoma
□ (H) Phyllodes tumor
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Old 10-06-2012
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f) medullary carcinoma ???
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Old 10-06-2012
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Default F meduallry carcinoma

medullary carcinoma... tumor with lymphocytic inflitrate.... good prognosis
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Old 10-06-2012
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Correct Answer

(F) Medullary carcinoma - most common breast cancer type associated with BRCA 1 mutation. (according to pathoma)

here's the picture:

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I go with e????
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Old 10-06-2012
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Medullary Carcinoma

BRCA1 association
lymphocyte infiltration
ER- PR negative.

I only know this tumor as ER- PR negative. Is there any other carcinoma of breast??
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Old 10-06-2012
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Correct Answer F is correct

Medullary carcinomas account for about 1% to 5% of all breast carcinomas. They tend to occur in women at
younger ages than do most other breast cancers. Despite poor prognostic indicators, such as absence of estrogen
receptors and progesterone receptors (ER-PR), medullary carcinomas have a better prognosis than most other breast
cancers. Perhaps the infiltrating lymphocytes are helpful. Colloid carcinomas occur about as frequently as medullary
carcinomas, but they are often positive for ER-PR, and the prognosis is better than average. Fibroadenomas are small
benign lesions that tend to stop enlarging after menopause, when hormonal stimulation has ceased. Infiltrating ductal and
infiltrating lobular carcinomas tend not to produce large, localized lesions because they are more invasive, and they lack a
distinct lymphoid infiltrate. Intraductal papillomas are unlikely to be larger than 1 cm. True papillary carcinomas are quite
rare, although other types of breast carcinoma may have a papillary component. The phyllodes tumor is typically large, but
it has stromal and glandular components.
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Endocrine-, Micrographs-, Pathology-, Step-1-Questions

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