Neoplasia: ductal carcinoma in situ of the breast: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: ductal carcinoma in situ of the breast

Sample item

A 52-year-old woman has linear branching pleomorphic calcifications on screening mammography. Core biopsy shows ducts distended by sheets of high-grade malignant cells with central necrosis and calcification, and the basement membrane is intact. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Comedo ductal carcinoma in situ

High-grade ductal carcinoma in situ commonly shows central comedo-type necrosis with dystrophic calcification, which is what produces the mammographic microcalcifications. By definition the cells stay inside the ducts with the basement membrane intact. Lobular carcinoma in situ is usually found incidentally and does not typically form a comedo pattern.

Option by option

  • A. Lobular carcinoma in situ

    Lobular carcinoma in situ shows discohesive uniform cells filling acini, without high-grade comedo necrosis.

  • B. Comedo ductal carcinoma in situ (correct)

    Correct. High-grade cells with comedo necrosis confined by an intact basement membrane indicate DCIS.

  • C. Invasive ductal carcinoma

    Invasive carcinoma requires breach of the basement membrane with stromal invasion.

  • D. Usual ductal hyperplasia

    Usual ductal hyperplasia shows a heterogeneous, streaming cell population without cytological atypia or necrosis.

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.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Comedo ductal carcinoma in situ. High-grade ductal carcinoma in situ commonly shows central comedo-type necrosis with dystrophic calcification, which is what produces the mammographic microcalcifications.

Why is "Lobular carcinoma in situ" not the answer?

Lobular carcinoma in situ shows discohesive uniform cells filling acini, without high-grade comedo necrosis.

Why is "Invasive ductal carcinoma" not the answer?

Invasive carcinoma requires breach of the basement membrane with stromal invasion.

Why is "Usual ductal hyperplasia" not the answer?

Usual ductal hyperplasia shows a heterogeneous, streaming cell population without cytological atypia or necrosis.

What concept does this question test?

It tests Neoplasia: ductal carcinoma in situ of the breast in Pathology. By definition the cells stay inside the ducts with the basement membrane intact. Lobular carcinoma in situ is usually found incidentally and does not typically form a comedo pattern.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: ductal carcinoma in situ of the breast?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.