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Chapter 17: Breast Pathology

The risk of developing breast carcinoma 10 or more years after a diagnosis of papilloma is:

A. Equivalent to the risk associated with atypical hyperplasia (ADH and ALH)

B. Higher than the risk associated with atypical hyperplasia (ADH and ALH)

C. Similar to the risk of proliferative disease without atypia (e.g., usual ductal hyperplasia)

D. Higher for patients with multiple papillomas

E. Unrelated to co-existing patterns of atypia in/adjacent to the papilloma(s)

Answer: D

Explanation: Data from the Nashville Cohort and the Mayo Clinic Benign Breast Disease Cohort show a relative risk of approximately 2 for benign papillomas, similar to proliferative disease without atypia. The relative risk associated with ADH and ALH is higher, approximately 4-5. The cancer risk associated with papillomas increases with multiplicity and coexisting atypical hyperplasia.

The risk of upgrade to carcinoma on excision after a core biopsy diagnosis of a solitary, benign, radiologically concordant papilloma is closest to:

A. 20%

B. 30%

C. 50%

D. 10%

E. 0%

Answer: E

Explanation: In recent studies with strict radiologic-pathologic correlation, the rate of upgrade to carcinoma (either ductal carcinoma in situ or invasive carcinoma) for solitary, benign, radiologically concordant papilloma is close to 0%. ADH has been associated with upgrade rates of 20–30% (choices A and B).

The risk of developing breast carcinoma 10 or more years after a diagnosis of flat epithelial atypia (FEA) is:

A. Equivalent to the risk associated with atypical hyperplasia (ADH and ALH)

B. Higher than the risk associated with atypical hyperplasia (ADH and ALH)

C. Similar to the risk of proliferative disease without atypia (e.g., usual ductal hyperplasia)

D. Higher in cases with multiple foci of FEA

E. Reduced substantially by chemoprevention with tamoxifen

Answer: C

Explanation: Data from the Nurses’ Health Study, Nashville Cohort, and the Mayo Clinic Benign Breast Disease Cohort show a relative risk of approximately 2 for columnar cell lesions and FEA, similar to proliferative disease without atypia. The relative risk associated with ADH and ALH is higher, approximately 4-5. There are no data on the number of foci of ...

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