Breast Q and A Book

BREAST SET 1 1. Identification: Persistence of epidermal thickenings along the milk line produces what structure? 2. MCQ: A congenital nipple inversion is usually significant only when: A. It occurs bilaterally B. It persists past puberty C. It presents later in life (acquired) D. It is associated with pain 3. Identification: What region of the breast contains 5–15 segments each with a major duct branching into lobules? 4. MCQ: Which quadrant contains ~50% of breast carcinomas? A. Upper inner B. Lower inner C. Upper outer D. Lower outer 5. MCQ: A painful erythematous breast during the first month of breastfeeding most likely indicates: A. Fat necrosis B. Acute mastitis C. Duct ectasia D. Inflammatory carcinoma 6. Identification: Which organism most commonly causes abscess-forming lactational mastitis? 7. MCQ: A recurrent, painful, erythematous subareolar mass in a smoker is characteristic of: A. Duct ectasia B. Squamous metaplasia of lactiferous ducts C. Fat necrosis D. Gynecomastia 8. Identification: What condition features keratinizing squamous metaplasia extending deep into ducts with keratin plugs? 9. MCQ: Duct ectasia is most common in which group? A. Nulliparous teens B. Multiparous women in 50s–60s C. Smokers D. Pregnant women 10. MCQ: Thick white nipple secretions, palpable periareolar mass, and occasional skin retraction suggest: A. Fat necrosis B. Duct ectasia C. Acute mastitis D. LCIS 11. Identification: A breast mass with lipid-laden macrophages within ectatic dilated ducts describes what? 12. MCQ: A firm irregular breast mass with calcifications following trauma is likely: A. Duct ectasia B. Fat necrosis C. Radial scar D. Fibroadenoma 13. Identification: Hard palpable masses associated with dense collagenized stroma and atrophic ducts are seen in what disorder common in type 1 diabetics? 14. MCQ: Granulomatous lobular mastitis occurs almost exclusively in: A. Nulliparous women B. Postmenopausal women C. Parous women D. Smokers 15. Identification: Granulomatous inflammation with lipid vacuoles surrounded by neutrophils describes what breast condition? 16. MCQ: Blue-dome cysts are characteristic of: A. Fat necrosis B. Fibrocystic changes C. DCIS D. LCIS 17. Identification: Cysts lined by apocrine cells with abundant granular eosinophilic cytoplasm occur in what breast change? 18. MCQ: Which breast lesion shows compressed and distorted acini within dense fibrotic stroma and can mimic invasive carcinoma? A. Radial scar B. Sclerosing adenosis C. Papilloma D. LCIS 19. Identification:Which lesion appears as a stellate mass with a central nidus of entrapped glands in elastotic stroma? 20. MCQ: Large central duct papillomas are most likely to cause what presentation? A. Skin retraction B. Galactorrhea C. Bloody nipple discharge D. Fever 21. Identification: Male breast enlargement with increased ducts and dense cellular stroma but almost no lobules is what? 22. MCQ: Gynecomastia may result from all EXCEPT: A. Cirrhosis B. Klinefelter syndrome C. Marijuana use D. High testosterone levels 23. Identification:A monomorphic epithelial proliferation partially filling ducts in a cribriform or micropapillary pattern describes what precursor lesion? 24. MCQ: Atypical lobular hyperplasia and LCIS share which feature? A. HER2 amplification B. Loss of E-cadherin C. Comedo necrosis D. Calcifications 25. Identification:Flat epithelial atypia is a columnar cell lesion with what defining feature? 26. MCQ: Calcium deposits within ducts forming linear or branching patterns on imaging strongly suggest: A. LCIS B. DCIS C. Fibrosis D. Papilloma 27. Identification: DCIS with “cookie cutter” round spaces filled with calcifying secretory material is what subtype? 28. Identification:Micropapillary DCIS produces bulbous protrusions lacking what structure? 29. MCQ: Paget disease of the nipple is caused by: A. LCIS cells entering the epidermis B. DCIS spreading up lactiferous ducts C. Invasion of basement membrane D. Trauma to the nipple epithelium 30. Identification:Erythematous nipple with scale crust and pruritus due to malignant cells in the epidermis is called what? 31. MCQ: Classic LCIS is characterized by: A. Comedo necrosis B. Calcifications C. Dyscohesive cells filling acini D. Stromal invasion 32. Identification: Loss of function of which adhesion protein explains LCIS cell dyscohesion? 33. MCQ: Risk of invasive carcinoma after LCIS develops at approximately what rate per year? A. 0.2% B. 1% C. 5% D. 10% 34. Identification: Mucin-positive signet ring cells may appear in what in-situ lesion? 35. MCQ: Luminal (ER+/HER2–) cancers arise primarily through which pathway? A. High-grade genomic instability pathway B. Low-grade ER-positive pathway C. HER2 amplification pathway D. TNBC basal-like pathway 36. Identification: Which cancers most often show loss of 16q and gain of 1q? 37. MCQ: HER2-positive cancers commonly involve amplification of what region? A. 1p B. 13q C. 17q12 D. 22q 40. Identification: A cancer arising from homologous recombination deficiency (often BRCA-related) is vulnerable to what class of drugs? 50. Identification: What lesion is a “button-like” subareolar mass in males caused by estrogen-androgen imbalance? SET 2 41. MCQ: In familial breast cancer, BRCA1/2 function as: A. Oncogenes B. Tumor suppressors C. Growth factors D. Hormone receptors 42. Identification: Germline CDH1 mutation predisposes to lobular carcinoma and what GI cancer? 43. MCQ: A breast carcinoma that is E-cadherin-negative is MOST likely: A. Invasive ductal B. Invasive lobular C. Medullary D. HER2-positive carcinoma 44. Identification: Cancer cells spreading singly or in “Indian file” patterns are typical of what invasive subtype? 45. MCQ: Which breast cancer type is most common in young women and most rapidly progressive? A. Luminal A B. LCIS C. Triple-negative D. Tubular carcinoma 46. Identification: A palpable, firm, rubbery, mobile mass in a young woman is most characteristic of what benign tumor? 47. MCQ: Phyllodes tumors arise from which tissue component? A. Ductal epithelium B. Intralobular stroma C. Interlobular stroma D. Myoepithelium 38. Identification: Triple-negative breast cancers commonly show what molecular feature? 48. Identification: A large, leaf-like mass with increased stromal cellularity and potential for malignancy is what tumor? 39. MCQ: Which germline mutation is MOST associated with triple-negative breast cancer? A. BRCA1 B. BRCA2 C. CHEK2 D. ATM 49. MCQ: Which type of intraductal papilloma is usually solitary and arises in the lactiferous sinuses? A. Peripheral papilloma B. Small duct papilloma C. Large duct papilloma D. Complex sclerosing lesion 1. Which age group most commonly develops fibroadenomas? A. Children B. Adolescents & young adults C. Women over 60 D. Postmenopausal men 2. First-line treatment for acute lactational mastitis is: A. Warm compresses only B. Broad-spectrum antifungals C. Continued breastfeeding + anti-staphylococcal antibiotics D. Immediate surgical drainage 3. Gynecomastia most often occurs in: A. Newborns B. Pubertal boys C. Elderly men D. All of the above 4. Phyllodes tumors are treated primarily with: A. Radiation alone B. Wide local excision C. Hormone therapy D. Observation only 5. HER2-positive breast cancers respond dramatically to: A. Tamoxifen B. Aromatase inhibitors C. Trastuzumab D. Methotrexate 6. Triple-negative breast cancers are most common in: A. Elderly women B. Pregnant/lactating women C. Younger premenopausal women D. Men 7. What is the standard systemic therapy for ER-positive breast cancer in premenopausal women? A. Aromatase inhibitors alone B. SERMs such as tamoxifen C. Androgen blockers D. PARP inhibitors 8. Which benign breast lesion is most frequent in smokers? A. Fibroadenoma B. Fat necrosis C. Squamous metaplasia of lactiferous ducts D. Gynecomastia 9. Major treatment for Paget disease of the breast? A. Topical steroids B. Antibiotics C. Management of underlying carcinoma (usually surgery ± radiation) D. Simple observation 10. Duct ectasia most often appears in: A. Teenage girls B. Nulliparous young adults C. Multiparous postmenopausal women D. Elderly men 11. Most common breast malignancy in men? A. LCIS B. Invasive ductal carcinoma C. Invasive lobular carcinoma D. Phyllodes tumor 12. Which is used as adjuvant endocrine therapy in postmenopausal ER+ breast cancer? A. Testosterone B. Aromatase inhibitors C. Dopamine agonists D. Progesterone-only therapy 13. Inflammatory breast carcinoma typically presents with: A. Sharp, well-circumscribed mass B. Peau d’orange skin C. Bloody nipple discharge D. Painless mobile lump 14. Best management of a simple breast cyst confirmed on ultrasound? A. Chemotherapy B. Antibiotics C. Aspiration if symptomatic D. Immediate surgical excision 15. Women with BRCA1 mutations are particularly predisposed to which subtype? A. ER-positive luminal A B. HER2 amplified C. Triple-negative basal-like D. LCIS 16. Mammographic calcifications are especially associated with: A. LCIS B. DCIS C. Fibroadenoma D. Fat necrosis only 17. Which breast tumor is most sensitive to hormone therapy? A. ER-positive cancer B. Triple-negative C. HER2-positive D. Metaplastic carcinoma 18. Older women (70+) most commonly develop which subtype? A. Luminal A B. Basal-like C. HER2 amplified D. Medullary 19. What’s the first step in evaluating bloody unilateral nipple discharge? A. MRI B. Cytology C. Breast ultrasound / mammogram D. Immediate mastectomy 20. First-line treatment for LCIS found incidentally on biopsy? A. Mandatory excision B. Bilateral mastectomy C. Surveillance ± chemoprevention D. Radiation therapy 21. Fat necrosis is commonly seen after: A. Menopause B. Breastfeeding C. Trauma or surgery D. Weight loss 22. Phyllodes tumors most commonly occur in: A. Adolescents B. Elderly women C. Middle-aged women D. Men 23. Which malignant subtype frequently shows “Indian file” cell patterns? A. Ductal B. Lobular C. Papillary D. Medullary 24. Breast cancer risk is increased by: A. Late menopause B. Early menarche C. Nulliparity D. All of the above 25. Which is a strong indication for PARP inhibitors? A. HER2+ disease B. BRCA mutation C. Tamoxifen failure D. DCIS 26. Which benign lesion may mimic cancer due to architectural distortion? A. Fat necrosis B. Sclerosing adenosis C. LCIS D. Gynecomastia 27. Core needle biopsy is preferred because it: A. Removes entire lesions B. Gives histology with minimal invasiveness C. Requires general anesthesia D. Cannot detect malignancy 28. Male breast carcinoma is most associated with: A. Low estrogen levels B. Gynecomastia C. Klinefelter syndrome D. Childhood trauma 29. Inflammatory breast cancer is staged as: A. T1 B. T2 C. T3 D. T4 30. Recurrent peri-areolar abscesses are usually due to: A. Autoimmune disease B. Diabetes C. Subareolar duct obstruction by keratin D. Trauma 31. Which subtype usually has the BEST prognosis? A. Luminal A B. Luminal B C. HER2-positive D. Triple-negative 32. First step in evaluating a breast mass in a young (<30) woman? A. Mammogram B. Ultrasound C. MRI D. PET scan 33. Risk of breast cancer lowest in: A. Early menarche B. Late menopause C. Breastfeeding D. Nulliparity 34. Which finding requires urgent imaging for possible inflammatory carcinoma? A. Nipple inversion since childhood B. Bilateral itching C. Rapid-onset erythema and edema D. Tiny mobile cyst 35. Receptor status is essential because it guides: A. Antibiotic selection B. Chemotherapy dosing C. Targeted therapy decisions D. Type of biopsy needle used 36. A postmenopausal woman with thick, dirty-white nipple discharge and a rubbery subareolar mass most likely has what condition? 37. A smoker presents with recurrent painful lumps beneath the nipple that keep forming abscesses. What diagnosis fits this pattern? 38. A breast lesion made of cysts lined by granular eosinophilic cells is describing what change? 39. A biopsy showing tightly packed glands compressed by dense fibrous tissue, giving an “almost cancer-like” appearance, most likely represents what? 40. A young woman has a well-defined, mobile, rubbery mass that moves with the skin. What is this classic presentation? 41. A malignant lesion with branching calcifications on mammography corresponds to what in-situ disease? 42. A breast tumor that spreads as single cells and avoids forming ducts suggests loss of what molecule? 43. A scaly, eczematous nipple lesion linked to underlying carcinoma is known as what? 44. A tumor showing “cookie-cutter” empty spaces in ducts refers to what subtype? 45. A large, lobulated tumor with exaggerated stromal growth forming leaf-like projections is describing what? 46. Clusters of lipid-filled macrophages inside wide ducts are characteristic of what benign issue? 47. A breast mass forming after a car accident is most likely in what condition? 48. A disease seen almost exclusively in women who have given birth, producing granulomas in lobules, is what? 49. A proliferation of atypical epithelial cells partially filling ducts, but not enough to qualify as carcinoma, is what? 50. A mass with a stellate center of trapped glands surrounded by elastic fibers describes what? 51. A breast cancer with overactive ER signaling but steady growth is probably which subtype? 52. A tumor that lacks ER, PR, and HER2 expression is categorized as what? 53. A cancer that frequently affects pregnant or young postpartum women and behaves aggressively is what subtype? 54. A benign lesion showing both increased ducts and loose cellular stroma in a male patient is what? 55. A lesion with bulbous intraluminal protrusions lacking fibrovascular cores is what architectural pattern of DCIS? 56. A breast disorder associated with keratin plugs that block ducts is what? 57. Breast pain, fever, and redness one week after delivery most likely indicate what infection? 58. A carcinoma notable for “Indian filing” and targetoid cell spreading refers to what? 59. A breast tumor with marked genomic instability, high mitotic rate, and pushing borders suggests what subtype? 60. A benign but cancer-mimicking change seen in diabetes and autoimmune thyroid disease is what? SET 3 (last na ‘to) 1. A 28-year-old breastfeeding mom develops fever, breast pain, and an erythematous wedge-shaped area on her breast. She continues to breastfeed. Most likely diagnosis? A. Fat necrosis B. Acute mastitis C. Duct ectasia D. Inflammatory carcinoma 2. A 52-year-old multiparous woman presents with thick white nipple discharge, a periareolar mass, and skin retraction. No fever. Most likely cause? A. Duct ectasia B. Paget disease C. Sclerosing adenosis D. LCIS 3. A 23-year-old woman has a mobile, rubbery, painless breast mass that shifts under the skin. Best diagnosis? A. Fibroadenoma B. Phyllodes tumor C. DCIS D. Fat necrosis 4. A 59-year-old smoker develops recurrent painful subareolar abscesses. Imaging shows dilated ducts with keratin debris. Which condition explains this? A. Acute mastitis B. Squamous metaplasia of lactiferous ducts C. Duct ectasia D. Galactocele 5. A 40-year-old woman presents after a car accident with a firm mass and calcifications on mammography. Diagnosis? A. Invasive carcinoma B. Fat necrosis C. DCIS D. Phyllodes tumor 6. A 34-year-old woman has painful cyclic breast nodularity with blue-domed cysts on imaging. Likely pathology? A. Fibrocystic changes B. LCIS C. Sclerosing adenosis D. Papilloma 7. A 45-year-old woman has bloody unilateral nipple discharge. The most common cause? A. LCIS B. Small duct papilloma C. Large central duct papilloma D. Invasive carcinoma 8. A 60-year-old woman with diabetes presents with a hard, irregular breast mass. Biopsy shows dense collagen and atrophic ducts. Diagnosis? A. Fat necrosis B. Lymphocytic mastopathy C. Duct ectasia D. Radial scar 9. A 47-year-old woman has a stellate lesion with trapped glands within elastic stroma on biopsy. What is it? A. Radial scar B. LCIS C. Phyllodes D. DCIS 10. A 33-year-old woman develops granulomas centered on breast lobules months after childbirth. Most likely diagnosis? A. Tuberculosis B. Granulomatous lobular mastitis C. Sarcoidosis D. Fat necrosis 11. A 54-year-old woman has microcalcifications in a linear branching pattern on mammogram. Most likely lesion? A. LCIS B. DCIS C. Radial scar D. Apocrine metaplasia 12. A biopsy shows ducts filled with cells forming round, uniform “cookie cutter” spaces. Diagnosis? A. Comedo DCIS B. Cribriform DCIS C. LCIS D. Papilloma 13. A woman presents with eczematous nipple changes and burning pain. Biopsy reveals malignant cells in the epidermis. Underlying mechanism? A. Spread of DCIS up lactiferous ducts B. Invasive carcinoma entering skin C. Infection D. Autoimmune disease 14. A 49-year-old woman has LCIS on biopsy. Mammograms are normal. Management? A. Mandatory excision B. Bilateral mastectomy C. Surveillance ± chemoprevention D. Radiation 15. A 56-year-old woman has a firm mass. Biopsy shows dyscohesive cells lacking E-cadherin. Which cancer? A. Ductal B. Lobular C. Medullary D. Mucinous 16. A 42-year-old woman with BRCA1 mutation develops a rapidly growing breast mass. Tumor is ER-, PR-, HER2-. Subtype? A. Luminal A B. HER2+ C. Triple-negative D. LCIS 17. A 67-year-old woman’s tumor is ER+, low mitotic rate, and well differentiated. Subtype? A. Luminal A B. Luminal B C. HER2+ D. TNBC 18. A breast tumor is HER2 amplified. What treatment is essential? A. Tamoxifen B. Aromatase inhibitors C. Trastuzumab D. PARP inhibitors 19. A 59-year-old woman has breast erythema, edema, and a peau d’orange appearance developing rapidly. Diagnosis? A. Cellulitis B. Inflammatory carcinoma C. Acute mastitis D. Fat necrosis 20. A breast cancer with pushing borders, high mitotic activity, and a basal-like profile most likely belongs to which category? A. Luminal A B. Triple-negative C. HER2+ D. Tubular carcinoma 21. A 22-year-old male has tender breast enlargement. Biopsy shows increased ducts and edema without lobules. Diagnosis? A. LCIS B. Gynecomastia C. Fat necrosis D. Duct ectasia 22. A 70-year-old male presents with a retroareolar hard mass. Biopsy shows malignant ducts. Most likely diagnosis? A. LCIS B. IDC C. Medullary carcinoma D. Phyllodes 23. A 32-year-old woman’s core biopsy shows proliferation partially filling ducts but lacking full DCIS criteria. What is this? A. LCIS B. ADH C. Fibroadenoma D. Radial scar 24. A core biopsy reveals increased acini per lobule surrounded by fibrotic tissue, mimicking carcinoma. Diagnosis? A. Sclerosing adenosis B. DCIS C. Fat necrosis D. Lymphocytic mastopathy 25. A breast lesion has both epithelial and stromal overgrowth, producing leaf-like projections. Diagnosis? A. Fibroadenoma B. Phyllodes tumor C. Papilloma D. LCIS 26. A 30-year-old lactating woman has a painless, milk-filled cyst after abrupt cessation of breastfeeding. What is it? A. Duct ectasia B. Fat necrosis C. Galactocele D. LCIS 27. A 64-year-old woman has a small tumor showing well-formed tubules and minimal atypia. Subtype? A. Tubular carcinoma B. Medullary carcinoma C. Mucinous carcinoma D. Lobular carcinoma 28. A breast cancer is mucin-rich and forms floating tumor cell clusters in pools of mucin. Likely diagnosis? A. Medullary B. Mucinous carcinoma C. Lobular D. HER2+ 29. A biopsy shows syncytial sheets of large cells with prominent lymphoplasmacytic infiltrate. Which subtype? A. Medullary carcinoma B. Tubular C. Papillary D. Fibroadenoma 30. A woman with long-standing type 1 diabetes develops a firm mass. Biopsy shows dense fibrosis and lymphocytes. Condition? A. Fat necrosis B. Duct ectasia C. Lymphocytic mastopathy D. Granulomatous mastitis 31. A 55-year-old woman has a mass near the nipple with a papilloma inside the main duct. Expected symptom? A. Fever B. Bloody discharge C. Diffuse swelling D. No symptoms 32. A postmenopausal woman has a mass composed of macrophages and cholesterol crystals inside dilated ducts. Most likely condition? A. LCIS B. Duct ectasia C. Papilloma D. Fat necrosis 33. A 37-year-old patient has an enlarging leaf-like mass. Surgery reveals high stromal cellularity. Most likely behavior? A. Benign always B. Locally recurrent if not widely excised C. Metastasizes early D. Hormone-driven 34. A woman with eczematous nipple findings is found to have underlying high-grade DCIS. What diagnosis connects both findings? A. Paget disease B. LCIS C. Apocrine metaplasia D. Fat necrosis 35. A breast lesion in a smoker shows keratin debris plugging ducts, causing fistulas. Diagnosis? A. Sclerosing adenosis B. Squamous metaplasia of lactiferous ducts C. DCIS D. LCIS 36. A patient develops a lump after seatbelt trauma. Biopsy shows foamy macrophages and necrotic fat. Diagnosis? A. Fat necrosis B. Duct ectasia C. Papilloma D. Fibroadenoma 37. A screening mammogram shows multiple cysts and apocrine change. Likely diagnosis? A. Fibrocystic changes B. Carcinoma C. LCIS D. Granulomatous mastitis 38. A tumor growing as single cells infiltrating the stroma, without gland formation, strongly suggests: A. Invasive ductal carcinoma B. Invasive lobular carcinoma C. Medullary carcinoma D. Mucinous carcinoma 39. A postpartum patient has severe breast erythema, swelling, warmth, and no clear mass. Which diagnosis is crucial to rule out? A. Fat necrosis B. Inflammatory carcinoma C. Duct ectasia D. LCIS 40. A proliferative lesion that increases breast cancer risk but is not malignant is: A. DCIS B. LCIS C. Atypical ductal hyperplasia D. Papilloma 41. Which subtype is ER+, HER2–, low proliferation? A. Luminal A B. Luminal B C. HER2+ D. TNBC 42. Which subtype is ER+, but high grade and proliferative? A. Luminal A B. Luminal B C. TNBC D. Medullary 43. HER2 amplification corresponds to which pathway? A. Low-grade ER pathway B. High-grade genomic instability C. Basal-like pathway D. Hormone-driven pathway 44. Which subtype is MOST common overall? A. Luminal A B. Luminal B C. HER2 amplified D. TNBC 45. Which subtype is most associated with BRCA1 mutation? A. Luminal A B. Luminal B C. TNBC D. HER2+ 46. Which subtype occurs more in older women? A. TNBC B. Luminal A C. HER2+ D. Medullary 47. Which subtype responds best to trastuzumab? A. Luminal B B. HER2 amplified C. TNBC D. LCIS 48. Which subtype has the worst short-term prognosis? A. Luminal A B. Luminal B C. HER2+ D. Triple-negative 49. Which subtype is most sensitive to endocrine therapy? A. Luminal A B. Luminal B C. TNBC D. Medullary 50. Which subtype characteristically lacks E-cadherin (in invasive form)? A. Ductal carcinoma B. Lobular carcinoma C. HER2+ tumors D. Mucinous carcinoma 51. Which subtype often shows pushing borders and a lymphocyte-rich infiltrate? A. Medullary carcinoma B. Tubular carcinoma C. Lobular carcinoma D. Papillary carcinoma 52. Tubular carcinoma belongs to which general category? A. Triple-negative B. HER2+ C. Low-grade luminal ER+ D. Medullary-like 53. Which subtype frequently has 17q12 amplification? A. TNBC B. Luminal A C. HER2+ D. LCIS 54. Which tumor is most likely ER–/PR–? A. Lobular B. Luminal A C. Triple-negative D. Tubular 55. Which subtype has the best long-term survival? A. Luminal A B. TNBC C. HER2+ D. Medullary 56. A tumor treated with aromatase inhibitors must be: A. ER+ B. HER2+ C. TNBC D. E-cadherin negative 57. PARP inhibitors are especially useful in: A. HER2+ tumors B. ER+ tumors C. BRCA-mutated cancers D. LCIS 58. A tumor negative for all receptors but positive for cytokeratin 5/6 and EGFR is likely: A. Luminal A B. Luminal B C. HER2+ D. Basal-like 59. Mucinous carcinoma tends to fall under which receptor profile? A. ER+ B. HER2+ C. Triple-negative D. AR+ only 60. Which subtype has the highest chance of recurrence in the first 3 years? A. Luminal A B. Triple-negative C. Lobular D. Papillary