Match each patient's clinical and histopathologic presentation to the most appropriate breast pathology diagnosis.
- A 55-year-old woman with a unilateral, spontaneous, bloody nipple discharge. Ultrasound demonstrates ductal dilation with a 1-cm intraluminal mass.Intraductal papilloma
- A 32-year-old woman with a rapidly enlarging, 7-cm firm breast mass. Core biopsy reveals a fibroepithelial lesion with cellular stroma and a 'leaf-like' architecture.Phyllodes tumor
- A 62-year-old woman with a persistent, eczematous, scaling rash over the right nipple. Biopsy demonstrates large cells with clear halos in the epidermis.Paget disease of the breast
- A 50-year-old woman with architectural distortion on mammography. Pathology shows malignant cells arranged in a single-file pattern due to loss of E-cadherin expression.Invasive lobular carcinoma
Answer
The correct matches are: bloody nipple discharge with intraluminal mass indicates intraductal papilloma; rapidly growing mass with leaf-like architecture indicates a phyllodes tumor; eczematous nipple rash with clear halo cells indicates Paget disease of the breast; and single-file malignant cells with E-cadherin loss indicates invasive lobular carcinoma.
Each clinical and histologic description is a classic hallmark for its respective diagnosis. Intraductal papilloma is the primary cause of bloody nipple discharge. Phyllodes tumors are defined by their leaf-like stromal projections. Paget disease is marked by eczematous nipple changes and intraepidermal clear cells. Invasive lobular carcinoma is characterized by E-cadherin loss resulting in single-file cell invasion.
Step-by-Step Solution
Key Concept
Clinicopathologic correlation of common breast lesions