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Pathology · Breast pathology
Sample itemA woman has a persistent scaly, eczema-like lesion of the nipple. Biopsy shows large cells with abundant pale cytoplasm lying singly and in nests within the epidermis. What is usually found in the underlying breast?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Ductal carcinoma in situ or invasive ductal carcinoma
Paget disease of the nipple is caused by malignant ductal cells extending up the lactiferous ducts into the nipple epidermis. Almost all cases have an underlying ductal carcinoma, in situ or invasive.
Option by option
A. Intraductal papilloma
Intraductal papilloma causes nipple discharge but is not associated with Paget cells.
B. Ductal carcinoma in situ or invasive ductal carcinoma (correct)
Paget cells are carcinoma cells that have spread along the ducts to the nipple skin.
C. Fat necrosis
Fat necrosis follows trauma and produces a firm lump, not intraepidermal malignant cells.
D. Fibroadenoma
Fibroadenoma is a benign stromal and epithelial tumour that does not infiltrate the epidermis.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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