BREAST

1. In familial breast cancer, the genes affected ____ ________.

A. Are required in homologous recombination repair
B. Produce loss of activation of p53
C. Inhibits apoptosis by inhibiting the RAS and PI3K-AKT pathways
D. Will produce tumors that fall in the Luminal subgroup

2. 30/F, 5 pack-year smoker, presents with skin flaking of the nipple. Biopsy done showed squamous
epithelium lining deep into the ductal system. The ducts are dilated by delicate keratin flakes. A
ruptured area shows intense mixed inflammatory infiltrates with a few foreign-body type
multinucleated giant cells. True of the lesion:
A. An underlying ductal carcinoma in-situ maybe present.
B. A relative deficiency of vitamin A is implicated in its development
C. A history of breast implants will be elicited on further history of the patient.
D. Multiparity and old age predisposes the patient to this lesion

3. True of fibroepithelial lesions of the breast:

A. Commonly harbor mutations in TERT
B. MED12 is only seen in phyllodes tumors
C. Complex features in a fibroadenoma is associated with slight increased risk of carcinoma
D. Lymphatic metastasis is the most common route of spread in malignant phyllodes.

4. While metastases to the breast are rare, they most likely come from:
A. Ovaries and Melanomas
B. Stomach and Melanomas
C. Endometrium and Ovaries
D. Fallopian tubes and Ovaries

5. 56/F underwent modified radical mastectomy of the right breast. Surgical pathology report showed
neoplastic cells in infiltrating linear, cords. These cells are dyscohesive and often seen surrounding
ducts. True of this lesion
A. This subtype will have prominent infiltrating T-lymphocytes which will have improved outcomes.
B. This is an indolent histologic type with a better prognosis in terms of metastatic spread.
C. This patient has a higher risk for developing a diffuse carcinoma of the stomach.
D. All of the above

6. Select the best statement for the given gross appearance below:
 A. Microscopically, this lesion will show infiltrative nests, glands and sheets of neoplastic cells that
have pleomorphic, hyperchromatic nuclei with prominent nucleoli set in a markedly
desmoplastic stroma
B. Ducts and ductules are compressed by a hypercellular stroma forming leaf-like structures
C. A slow, indolent growth with a low propensity to induce desmoplasia in this lesion makes it
difficult to identify by imaging studies
D. A modified radical mastectomy with adequate margins and follow up with chemotherapy is
adequate for treatment.

7. The IHC marker, if negative, can be used to distinguish whether this lesion is benign or a carcinoma
is:

A. CK5/6
B. HER2
C. panCK
D. ER

8. A 39/F underwent MRM of the right breast. On serial section, a cream white granular mass is
present. This measures 2.0 x 1.5 x 2.0 cm, and is seen 6.0 cm, 5.0 cm, 8.0 cm, 7.0 cm from the
superior margin, inferior margin, lateral margin and medial margin, respectively. The mass abuts the
skin and posterior margin. The overlying skin ellipse shows dimpling, and an ulcer continuous with
the mass is identified. Four of ten axillary lymph nodes show metastases, the smallest metastatic
deposit measuring 0.2 cm, while the largest measures 1.0 cm. What is the TNM staging of this
patient?
A. T4aN2a
B. T4bN2a
C. T2N2a
D. T1cN2a
9. Isolated tumor cells are defined as:
A. fewer than 100 cells
B. clusters of cells measuring < 0.2 mm
C. 1000 tumor cells in one deposit
D. None of the above
10. Two smears are received for consultation, stated to contain aspirates from a right breast nodule in a
28/F. Upon inquiry with the clinician, she states that the aspirate was thick, with a yellowish hue. The
smears are paucicellular, showing few flat sheets of epithelial cells with abundant granular
cytoplasm, which have centrally located round nuclei. Scattered in the background are histiocytes
with abundant vacuolated cytoplasm. What is the diagnosis?
A. Malignant, suspicious for ductal carcinoma
B. Benign, fibroadenoma
C. Benign, fibrocystic changes
D. Malignant, suspicious for lobular carcinoma