A 38-year-old woman presents for evaluation to a clinic with painful ulceration in her right breast for the last 2 months. She is worried because the ulcer is increasing in size. On further questioning, she says that she has a discharge from her right nipple as well. Her mother and aunt died of breast cancer at 60 and 54 years of age, respectively. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3x3 cm. Mammography is ordered that shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue and trabecular thickening in the aflected breast. The patient subsequently undergoes core needle and full-thickness skin punch biopsies. The pathology report states a clear dermal lymphatic invasion by tumor cells. Which of the following is the most common site for metastatic disease in this pathology?

Питання КРОК 1 (медицина) · тест з варіантами та поясненням · Medus

EN: A 38-year-old woman presents for evaluation with painful ulceration in her right breast for the last 2 months. The ulcer is increasing in size. She has discharge from her right nipple. Her mother and aunt died of breast cancer at 60 and 54 years of age. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3×3 cm. Mammography shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue and trabecular thickening. Pathology report: clear dermal lymphatic invasion by tumor cells. Which of the following is the most common site for metastatic disease in this pathology?

Варіанти відповідей

1. Deep anterior cervical, abdominal lymph nodes
2. Deep lateral cervical, superior diaphragmatic lymph nodes
3. Parasternal, tracheobronchial lymph nodes
4. Axillary, supraclavicular lymph nodes
5. Preaortic, tracheobronchial lymph nodes

Answer options (EN)

1. Deep anterior cervical, abdominal lymph nodes
2. Deep lateral cervical, superior diaphragmatic lymph nodes
3. Parasternal, tracheobronchial lymph nodes
4. Axillary, supraclavicular lymph nodes
5. Preaortic, tracheobronchial lymph nodes

Правильна відповідь

Axillary, supraclavicular lymph nodes

Пояснення

Опис відповідає інфільтративному раку молочної залози (наприклад воспаленому) з лімфангіальним поширенням. Перший рівень метастазування - аксилярні лімфовузли, далі надключичні. Парастернальні та трахеобронхіальні страждають при внутрішньочастковому поширенні; черевні та преаортальні - при віддалених метастазах.

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• 2022 рік, 1 день (English)

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