Most common in postmenopausal women:
1) fibrocystic changes, intraductal papilloma, Fibroadenoma
More likely in postmenopausal women: 1) phyllodes tumor (fibroadenoma-like tumor) 2) Breast cancers increased risk d/t 1) increased age, duration of estrogen throughout life (early menarche, late menopause, obesity) 2) Atypical hyperplasia 3) First degree relatives
Question states presents it as: a) 2cm firm, nontender mass b) no axillary lymphadenopathy or nipple discharge c) extremly radiodense mass with irregular margins clustered irregular microcalcifications
so what can it be: 1) DICS = does not usually produce mass
2) Comedo type = high- grade cells with necrosis & dystrophic calcifications at center of duct
3) Paget Disease = involves the skin of the nipple (underlying carcinoma)
4) IDC = a) forms duct-like structures (>80% of cases) b) mass detected by physical examination (check) c) usually 1cm or greater (check) d) Desmoplastic stroma = connective tissue growing with tumor (supports tumor) ~~~ (check -- irregular margins) e) Medullary Carcinome (IDC) = mimics fibroadenoma
5) LCIS & ILC = DO NOT produce calcifications or mass a) ILC - cells have "single-file pattern" think of a beaded necklace and you cut it in middle (lack E-cadherin)
Could also use the patient's age to make the differential. Age is a risk factor related to breast cancer (common in post-menopausal women, unless there's a history of breast cancer in the family).
Fibrocystic changes and fibroadenomas are usually common in premenopausal women.
No discharge noted, so it's not an intraductal papilloma.
The answer is carcinoma of the breast. I get that, but I’m having trouble figuring out which Carcinoma of Breast it is. I’m stuck between DCIS, and Invasive Ductal Carcinoma. I’m leaning towards Invasive Ductal Carcinoma, just because it’s (1) most common and (2) the mass with irregular margins in clusters sounds like it could be ‘stellate infiltration’, seen in Invasive Ductal Carcinoma. But I’m not sure. Can anyone help?
In addition to what everyone else said, they went out of their way to use the word "irregular" TWICE. Maybe simple-minded of me, but as far as I understand benign shtuff is rarely irregular.
What are the words that point to Carcinoma rather than Fibrocystic or Fibroadenoma or Fat Necrosis (not an answer)?
Those can have masses and calcifications right? Is it only the irregular margins?
The mass is in the outer upper quadrant, this is why it want DCIS. Nice and simple
this is not mentioned in FA or pathoma, but according to Amboss:
In invasive ductal carcinoma, the mammography finding shows "star-shaped lesion occurs due to clustered microcalcifications of the surrounding tissue."
It is not DCIS because DCIS doesn't produce a mass It is not fibroadenoma (it is most common in women <35) It is not fibrocystic changes (premenopausal women 20-50, often bilateral, tender)