Breast pathology US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Breast pathology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Breast pathology US Medical PG Question 1: A researcher is studying the ability of breast cancer cells to metastasize. Neoplastic cells obtained from 30 patients with stage IV ductal carcinoma of the breast are tagged with a fluorescent antibody. The cells are then inserted into a medium resembling normal human tissue. After 2 weeks, all samples show in vitro hematogenous invasion and migration away from the original site of insertion. Which of the following properties is most likely responsible for the ability of these neoplastic cells to metastasize?
- A. Loss of cellular polarity
- B. Presence of fibrous tissue capsule
- C. Overexpression of HER2/neu
- D. Increase in N:C ratio
- E. Release of matrix metalloproteinase (Correct Answer)
Breast pathology Explanation: ***Release of matrix metalloproteinase***
- **Matrix metalloproteinases (MMPs)** degrade components of the **extracellular matrix (ECM)** and **basement membrane**, allowing cancer cells to invade surrounding tissues and metastasize [1].
- The in vitro observation of **hematogenous invasion** and **migration** confirms the ability to break down barriers critical for metastasis [2].
*Loss of cellular polarity*
- While **loss of polarity** is a feature of malignant transformation, it primarily contributes to disorganized growth and invasion rather than the active breakdown of the physical barriers required for long-distance metastasis.
- It does not directly explain the enzymatic degradation of the **ECM** necessary for transmural passage into blood vessels [2].
*Presence of fibrous tissue capsule*
- A **fibrous tissue capsule** typically indicates a **benign tumor** or a well-demarcated malignant tumor with limited invasiveness, restricting spread.
- Its presence would hinder, rather than promote, the ability of cancer cells to metastasize.
*Overexpression of HER2/neu*
- **HER2/neu overexpression** is a marker of aggressive breast cancer and can promote cell proliferation and survival.
- However, it does not directly facilitate the enzymatic degradation of the **extracellular matrix** required for active invasion and migration [2].
**References:**
[1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 232-233.
[2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 314-316.
Breast pathology US Medical PG Question 2: A 56-year-old woman presents to a physician for evaluation of a lump in her left breast. She noticed the lump last week while taking a shower. She says that the lump seemed to be getting larger, which worried her. The lump is not painful. The medical history is unremarkable. She has smoked cigarettes for the last 30 years. On examination, bilateral small nodules are present that are non-tender and immobile. A mammography confirms the masses and fine needle aspiration cytology of the lesions reveals malignant cells arranged in a row of cells. What is the most likely diagnosis?
- A. Fibroadenoma
- B. Mucinous carcinoma
- C. Inflammatory carcinoma
- D. Invasive lobular carcinoma (Correct Answer)
- E. Invasive ductal carcinoma
Breast pathology Explanation: ***Invasive lobular carcinoma***
- The classic presentation of **invasive lobular carcinoma** includes **bilateral, non-tender, immobile masses** and malignant cells arranged in a **single-file pattern** on FNA, often described as "**Indian files**".
- This type of cancer frequently presents with subtle thickening or diffuse induration rather than well-defined masses due to its infiltrative growth pattern.
*Fibroadenoma*
- **Fibroadenomas** are typically **benign, mobile, well-defined** masses, often described as "rubbery" or "slippery," unlike the immobile nodules described.
- While they can be firm, they do not show malignant cells on FNA or the classic "Indian file" arrangement.
*Mucinous carcinoma*
- **Mucinous carcinoma** is characterized by the presence of tumor cells floating in abundant **extracellular mucin**, which would be evident on FNA.
- This typically presents as a **soft, gelatinous mass**, which doesn't align with the description of firm, immobile nodules.
*Inflammatory carcinoma*
- **Inflammatory carcinoma** presents with characteristic inflammatory signs like **redness, warmth, swelling, and peau d'orange** (orange peel skin appearance) due to dermal lymphatic invasion.
- These prominent skin changes are not mentioned in the patient's presentation.
*Invasive ductal carcinoma*
- **Invasive ductal carcinoma** usually presents as a **solitary, firm, irregular mass** and on FNA typically shows malignant cells in **duct-like structures** or disorganized clusters, not characteristically in single-file lines.
- While it is the most common type of breast cancer, the specific "Indian file" arrangement points more strongly to lobular carcinoma.
Breast pathology US Medical PG Question 3: An otherwise healthy 45-year-old woman comes to the physician because of a 2-week history of an itchy rash on her left nipple. The rash began as small vesicles on the nipple and spread to the areola. It has become a painful ulcer with yellow, watery discharge that is occasionally blood-tinged. She has asthma treated with theophylline and inhaled salbutamol. Her younger sister was diagnosed with endometrial cancer a year ago. Examination shows a weeping, ulcerated lesion involving the entire left nipple-areolar complex. There are no breast masses, dimpling, or axillary lymphadenopathy. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Breast abscess
- B. Breast fibroadenoma
- C. Inflammatory breast cancer
- D. Mastitis
- E. Paget disease of the breast (Correct Answer)
Breast pathology Explanation: ***Paget disease of the breast***
- The presentation of a **pruritic (itchy) rash** on the nipple and areola that progresses to an **ulcerated lesion with discharge**, especially in an older woman, is highly classic for **Paget disease of the breast**.
- This condition is often associated with an underlying **ductal carcinoma in situ** or **invasive breast cancer**, even in the absence of a palpable mass. This case describes an **itchy rash** that is **ulcerated with a yellow, watery, and blood-tinged discharge**, which are classic clinical features.
*Breast abscess*
- A breast abscess typically presents as a painful, **fluctuant mass** with surrounding **erythema** and **inflammation**, often accompanied by fever and systemic symptoms.
- It usually does not start as a diffuse rash with a gradual progression to ulceration; instead, it develops from a localized infection.
*Breast fibroadenoma*
- A fibroadenoma is a **benign, solid tumor** of the breast that typically presents as a **well-defined, mobile, non-tender lump** and does not involve skin changes like rashes, ulceration, or discharge from the skin surface.
- It would not cause an itchy, spreading rash on the nipple.
*Inflammatory breast cancer*
- Inflammatory breast cancer presents with characteristic signs of **peau d'orange (orange peel skin)**, **erythema**, warmth, and edema affecting a large portion of the breast, often mistaken for mastitis.
- It typically does not begin as a localized nipple rash progressing to ulceration; rather, it involves a rapid onset of diffuse skin changes due to dermal lymphatic invasion.
*Mastitis*
- Mastitis is an **infection of the breast tissue**, typically occurring in lactating women, and presents with **localized pain, redness, warmth, and swelling**, often with fever.
- While it can cause skin changes and discharge, it usually presents as a more acute, inflammatory process across a broader area of the breast, not specifically as a primary ulcerative lesion of the nipple-areola complex.
Breast pathology US Medical PG Question 4: A 46-year-old premenopausal woman undergoes lumpectomy after a diagnosis of invasive ductal carcinoma of the breast is made. Pathologic examination of the surgical specimen shows that the breast cancer cells stain positive for estrogen receptor and progesterone receptor, and negative for human epidermal growth factor receptor 2. Which of the following characteristics applies to the most appropriate pharmacotherapy for this patient's condition?
- A. Monoclonal antibody against tyrosine kinase receptor
- B. Monoclonal antibody against vascular endothelial growth factor
- C. Selective agonist at progesterone receptors in mammary tissue
- D. Selective agonist at estrogen receptors in bone tissue
- E. Selective antagonist at estrogen receptors in mammary tissue (Correct Answer)
Breast pathology Explanation: ***Selective antagonist at estrogen receptors in mammary tissue***
- The patient's tumor is **estrogen receptor (ER) positive** and **progesterone receptor (PR) positive**. This indicates a **hormone-sensitive cancer**, making endocrine therapy the most appropriate pharmacotherapy.
- A **selective antagonist at estrogen receptors** in mammary tissue, such as **tamoxifen** (a selective estrogen receptor modulator, SERM), is effective in blocking estrogen-mediated tumor growth in premenopausal patients.
*Monoclonal antibody against tyrosine kinase receptor*
- This therapy, typically targeting **HER2 (human epidermal growth factor receptor 2)**, would be appropriate if the tumor was **HER2-positive**.
- The patient's tumor is **HER2-negative**, meaning this type of targeted therapy would not be beneficial.
*Monoclonal antibody against vascular endothelial growth factor*
- This class of drugs, like **bevacizumab**, targets **angiogenesis** by inhibiting VEGF, which is crucial for tumor blood supply.
- While used in some cancers, it is not the primary or most appropriate pharmacotherapy based on the specific receptor status of this patient's breast cancer.
*Selective agonist at progesterone receptors in mammary tissue*
- An **agonist** at progesterone receptors would **promote growth** if the tumor is progesterone receptor-positive, which would be counterproductive for cancer treatment.
- The goal of endocrine therapy for PR-positive tumors is to inhibit the effects of progesterone.
*Selective agonist at estrogen receptors in bone tissue*
- An agonist at estrogen receptors in bone tissue would **mimic estrogen's effects**, which is undesirable given the estrogen-sensitive nature of the breast cancer.
- While some SERMs (like tamoxifen) can have agonist effects in bone (which can be beneficial for bone density), the primary therapeutic action for breast cancer is antagonism in mammary tissue.
Breast pathology US Medical PG Question 5: A 52-year-old female was found upon mammography to have branching calcifications in the right lower breast. Physical exam revealed a palpable nodularity in the same location. A tissue biopsy was taken from the lesion, and the pathology report diagnosed the lesion as comedocarcinoma. Which of the following histological findings is most likely present in the lesion?
- A. Disordered glandular cells invading the ductal basement membrane
- B. Pleomorphic cells surrounding areas of comedonecrosis (Correct Answer)
- C. Extensive lymphocytic infiltrate
- D. Halo cells in epidermal tissue
- E. Orderly rows of cells surrounding lobules
Breast pathology Explanation: ***Pleomorphic cells surrounding areas of comedonecrosis***
- **Comedocarcinoma** specifically refers to a high-grade subtype of **ductal carcinoma in situ (DCIS)** characterized by **central necrosis (comedonecrosis)** surrounded by **pleomorphic epithelial cells**.
- The presence of branching calcifications on mammography is also a classic sign often associated with **comedonecrosis** within the ducts.
*Disordered glandular cells invading the ductal basement membrane*
- This description is characteristic of **invasive ductal carcinoma**, where malignant cells breach the basement membrane and infiltrate surrounding tissues, which is not stated in the diagnosis of comedocarcinoma.
- Comedocarcinoma is a form of **carcinoma in situ**, meaning the cancerous cells are confined within the ductal system and have not yet invaded the basement membrane.
*Extensive lymphocytic infiltrate*
- While immune cell infiltrates can be seen in various cancers, an **extensive lymphocytic infiltrate** is more characteristic of conditions like **medullary carcinoma** of the breast or specific immune responses, not a defining feature of comedocarcinoma.
- It does not directly relate to the characteristic histological appearance of **comedonecrosis** and **pleomorphic cells** seen in comedocarcinoma.
*Halo cells in epidermal tissue*
- **Halo cells** (koilocytes) are characteristic of **human papillomavirus (HPV) infection** and are found in **cervical or anal squamous lesions**, not typically in breast tissue.
- This finding is completely unrelated to breast pathology and specifically to comedocarcinoma.
*Orderly rows of cells surrounding lobules*
- This description is more indicative of **lobular carcinoma in situ (LCIS)** or some benign proliferative lesions, where cellular architecture tends to maintain some order.
- **Comedocarcinoma** involves disordered, pleomorphic cells within ducts, often with central necrosis, and does not form orderly rows surrounding lobules.
Breast pathology US Medical PG Question 6: A 40-year-old man presents with a painless firm mass in the right breast. Examination shows retraction of the nipple and the skin is fixed to the underlying mass. The axillary nodes are palpable. Which of the following statements is FALSE regarding the above condition?
- A. Lobular cancer is the most common breast cancer in males (Correct Answer)
- B. BRCA2 mutations are associated with increased risk
- C. These are positive for estrogen receptor
- D. Endocrine therapy plays an important role in treatment
- E. Gynecomastia may be caused by certain medications
Breast pathology Explanation: ***Lobular cancer is the most common breast cancer in males***
- This statement is **FALSE** and is the correct answer. The most common type of breast cancer in males is **invasive ductal carcinoma (IDC)**, accounting for about 80-90% of cases.
- **Invasive lobular carcinoma** is rare in men because men have very few lobules in their breast tissue.
*Gynecomastia may be caused by certain medications*
- This statement is **TRUE**. Medications such as spironolactone, cimetidine, finasteride, antipsychotics, and anabolic steroids can cause gynecomastia.
- However, the clinical presentation described (firm mass, nipple retraction, skin fixation, axillary nodes) is consistent with **malignancy**, not gynecomastia.
*BRCA2 mutations are associated with increased risk*
- This statement is **TRUE**. Male breast cancer is strongly associated with **BRCA2 mutations** (and less commonly BRCA1), which are hereditary.
- Men with BRCA2 mutations have a 5-10% lifetime risk of developing breast cancer, compared to less than 0.1% in the general male population.
*These are positive for estrogen receptor*
- This statement is **TRUE**. A vast majority (over 90%) of male breast cancers are **estrogen receptor (ER) positive**, which makes them responsive to endocrine therapy.
- This high rate of ER positivity is even greater than in female breast cancers.
*Endocrine therapy plays an important role in treatment*
- This statement is **TRUE**. Given the high prevalence of ER positivity (over 90%), endocrine therapy such as **tamoxifen** or aromatase inhibitors is a cornerstone of treatment for male breast cancer.
- Endocrine therapy is used in both adjuvant and metastatic settings for hormone receptor-positive disease.
Breast pathology US Medical PG Question 7: A 34-year-old woman visits an outpatient clinic with a complaint of pain in her left breast for the last few months. The pain worsens during her menstrual cycle and relieves once the cycle is over. She denies any nipple discharge, skins changes, warmth, erythema, or a palpable mass in the breast. Her family history is negative for breast, endometrial, and ovarian cancer. There is no palpable mass or any abnormality in the physical examination of her breast. A mammogram is ordered which shows a cluster of microcalcifications with a radiolucent center. A breast biopsy is also performed which reveals a lobulocentric proliferation of epithelium and myoepithelium. Which of the following is the most likely diagnosis?
- A. Intraductal papilloma
- B. Fibroadenoma
- C. Sclerosing adenosis (Correct Answer)
- D. Ductal hyperplasia without atypia
- E. Infiltrating ductal carcinoma
Breast pathology Explanation: ***Sclerosing adenosis***
- The combination of **cyclical mastalgia**, **microcalcifications with a radiolucent center** on mammography, and a biopsy showing **lobulocentric proliferation of epithelium and myoepithelium** is highly characteristic of sclerosing adenosis.
- Sclerosing adenosis is a **benign proliferative lesion** of the breast that can mimic malignancy clinically and radiologically due to its firm consistency and calcifications.
*Intraductal papilloma*
- This typically presents with **bloody or serous nipple discharge** and is often associated with a mass near the nipple, which are not present in this case.
- Histologically, it involves a papillary growth within a duct, not a lobulocentric proliferation.
*Fibroadenoma*
- This presents as a **well-circumscribed, palpable, mobile mass** that is typically rubbery and not usually associated with cyclical pain as the primary symptom.
- Mammographically, it appears as a well-defined mass, often with coarse calcifications, but the specific **radiolucent center** in clustered microcalcifications is less typical.
*Ductal hyperplasia without atypia*
- While it can manifest as microcalcifications, it typically does not present with significant cyclical pain as the main symptom.
- Histopathologically, it involves an increase in the number of **epithelial cells in the ducts** but without the lobulocentric proliferation of both epithelial and myoepithelial cells seen in sclerosing adenosis.
*Infiltrating ductal carcinoma*
- This is a **malignant condition** that should be considered with new breast pain and microcalcifications, but the absence of a palpable mass, skin changes, nipple discharge, and the specific biopsy findings make it less likely.
- While it can present with microcalcifications, the histological finding of **lobulocentric proliferation of epithelium and myoepithelium** is inconsistent with invasive carcinoma.
Breast pathology US Medical PG Question 8: A 34-year-old Ethiopian woman who recently moved to the United States presents for evaluation to a surgical outpatient 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 also has a discharge from her right nipple. She had her 2nd child 4 months ago and was breastfeeding the baby until the pain started getting worse in the past few weeks, and is now unbearable. According to her health records from Africa, her physician prescribed antimicrobials multiple times with a diagnosis of mastitis, but she did not improve significantly. Her mother and aunt died of breast cancer at 60 and 58 years of age, respectively. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3 × 3 cm. White-gray nipple discharge is present. The breast is tender with axillary and cervical adenopathy. Mammography is ordered, which shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue and trabecular thickening in the affected breast. The patient subsequently undergoes core-needle and full-thickness skin punch biospies. The pathology report states a clear dermal lymphatic invasion by tumor cells. Which of the following is the most likely diagnosis?
- A. Infiltrating ductal carcinoma
- B. Infiltrating lobular carcinoma
- C. Inflammatory breast cancer (Correct Answer)
- D. Ductal carcinoma in situ (DCIS)
- E. Lobular carcinoma in situ (LCIS)
Breast pathology Explanation: ***Inflammatory breast cancer***
- The rapid onset of **diffuse erythema**, **edema** (peau d'orange appearance due to lymphatic involvement), **skin thickening**, ulceration, and the palpable **axillary and cervical adenopathy** are classic signs of inflammatory breast cancer.
- The mammographic findings of **parenchymal distortion**, extensive soft tissue, **trabecular thickening**, and especially the **dermal lymphatic invasion** by tumor cells on biopsy confirm this aggressive diagnosis.
*Infiltrating ductal carcinoma*
- While **infiltrating ductal carcinoma** is the most common type of breast cancer, it typically presents as a **palpable mass** or an abnormal mammogram finding without the prominent inflammatory signs seen here.
- It usually does not involve such widespread **dermal lymphatic invasion** and rapid progression with skin changes, unless it is a specific variant with inflammatory features.
*Infiltrating lobular carcinoma*
- This type of carcinoma often grows in a **diffuse pattern** and may not form a distinct mass, sometimes making it difficult to detect by mammography.
- However, it rarely presents with the prominent **inflammatory signs** (erythema, edema, skin thickening) and ulceration indicative of extensive dermal lymphatic involvement as described.
*Ductal carcinoma in situ (DCIS)*
- **DCIS** is a non-invasive form of breast cancer confined to the breast ducts, meaning it has not spread beyond the ductal basement membrane.
- It typically presents as **microcalcifications** on mammography and does not exhibit a rapidly progressing **painful ulceration**, **skin changes**, or **lymph node involvement**.
*Lobular carcinoma in situ (LCIS)*
- **LCIS** is a non-invasive condition that increases the risk of developing invasive breast cancer in either breast.
- It is an **incidental finding** on biopsy for another reason, does **not form a mass**, and does not cause the **clinical signs of inflammation**, skin changes, or ulceration.
Breast pathology US Medical PG Question 9: A 56-year-old woman, gravida 3, para 3, comes to the physician because her left breast has become larger, hot, and itchy over the past 2 months. The patient felt a small lump in her left breast 1 year ago but did not seek medical attention at that time. She has hypertension and hyperlipidemia. Menarche was at the age of 11 years and menopause at the age of 46 years. Her mother died of breast cancer at the age of 45 years. The patient does not smoke or drink alcohol. Current medications include labetalol, simvastatin, and daily low-dose aspirin. She is 170 cm (5 ft 7 in) tall and weighs 78 kg (172 lb); BMI is 27 kg/m2. Her temperature is 37.7°C (99.9°F), pulse is 78/min, and blood pressure is 138/88 mm Hg. Examination shows large dense breasts. There is widespread erythema and edematous skin plaques over a breast mass in the left breast. The left breast is tender to touch and left-sided axillary lymphadenopathy is noted. Which of the following is the most likely diagnosis?
- A. Paget's disease of the breast
- B. Inflammatory breast cancer (Correct Answer)
- C. Mastitis
- D. Breast fibroadenoma
- E. Breast abscess
Breast pathology Explanation: ***Inflammatory breast cancer***
- The rapid onset of a **hot, itchy, and enlarged breast** with widespread **erythema and edematous skin plaques** (peau d'orange appearance) covering a breast mass, along with **axillary lymphadenopathy** and a history of a growing lump, are classic signs of inflammatory breast cancer.
- Inflammatory breast cancer is an aggressive form of breast cancer characterized by cancer cells blocking lymph vessels in the skin of the breast, leading to these distinctive inflammatory symptoms.
*Paget's disease of the breast*
- Typically presents as a **red, scaly, patchy rash** resembling eczema on the nipple and areola, sometimes with itching or burning.
- While it is a type of breast cancer, it usually does not cause the diffuse breast enlargement, warmth, and widespread edematous plaques seen in this case.
*Mastitis*
- Although it causes a **hot, red, and painful breast** and can be accompanied by fever, mastitis is typically associated with **lactation** and presents more acutely.
- The presence of a long-standing "small lump" that has grown and the specific "peau d'orange" skin changes make mastitis less likely than cancer.
*Breast fibroadenoma*
- Fibroadenomas are **benign, solid lumps** that are typically **painless, movable, and rubbery**.
- They do not cause diffuse breast enlargement, heat, itching, skin changes like erythema and edema, or axillary lymphadenopathy.
*Breast abscess*
- A breast abscess is a **localized collection of pus** within the breast, often following mastitis, characterized by severe localized pain, redness, swelling, and sometimes a fluctuant mass.
- While it causes warmth and tenderness, the **widespread edematous plaques** and diffuse nature of the skin changes, coupled with a history of a growing lump, are more indicative of inflammatory breast cancer.
Breast pathology US Medical PG Question 10: A 44-year-old woman presents for her annual physical checkup. She says she first noticed a mass in her right breast while taking a shower 3 months ago, which has progressively increased in size. She denies any weight loss, fever, night sweats, discharge from or change in her nipples. Her family history is negative for breast, ovarian, and endometrial cancer. She is afebrile, and her vital signs are within normal limits. Physical examination reveals a smooth, multinodular, firm 5 cm x 5 cm mass in the right breast that is mobile and painless. The skin over the mass appears to be stretched and shiny without ulcerations, erythema, or vascular demarcation. On follow-up 6 weeks later, an interval ultrasound of the right breast reveals a well-circumscribed hypoechoic mass with some cystic components that now measures 8 cm x 7 cm. A core needle biopsy of the mass is performed. Which of the following diagnosis is most likely expected to be confirmed by the core needle biopsy in this patient?
- A. Fibroadenoma
- B. Breast abscess
- C. Fat necrosis
- D. Duct ectasia
- E. Phyllodes tumor (Correct Answer)
Breast pathology Explanation: ***Phyllodes tumor***
* The clinical presentation of a rapidly growing, large, **mobile, firm, and painless breast mass** in a middle-aged woman is highly suggestive of a phyllodes tumor.
* Ultrasound findings of a **well-circumscribed hypoechoic mass with cystic components** are also characteristic, as is the significant interval increase in size.
*Fibroadenoma*
* While fibroadenomas are typically **mobile and painless**, they usually grow more slowly and rarely reach the large size (8 cm) observed in this patient.
* Significant rapid growth and a multinodular appearance make fibroadenoma less likely, although phyllodes tumors can sometimes be mistaken for fibroadenomas on initial imaging.
*Breast abscess*
* A breast abscess typically presents with signs of **inflammation, pain, redness, warmth, and possibly fever**, which are absent in this case.
* Ultrasound would show a fluid-filled collection with internal debris, often with surrounding inflammatory changes.
*Fat necrosis*
* Fat necrosis usually occurs after **trauma or surgery** to the breast and often presents as a firm, fixed mass that can mimic malignancy.
* The absence of trauma history and the rapid, significant growth are inconsistent with fat necrosis.
*Duct ectasia*
* Duct ectasia commonly causes **nipple discharge**, subareolar masses, and sometimes nipple retraction.
* The patient denies nipple discharge, and the mass characteristics do not align with typical duct ectasia.
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