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JAMA Surgery Clinical Challenge
March 2014

Enlarging Breast Mass in a 55-Year-Old Woman

Author Affiliations
  • 1Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan
JAMA Surg. 2014;149(3):305-306. doi:10.1001/jamasurg.2013.1249

A 55-year-old woman presented to the clinic with a mass in her left breast that had been enlarging over the previous 3 months. The patient denied any antecedent trauma or infection. Her medical history was significant for hypertension and left breast invasive ductal carcinoma in 2007 treated with lumpectomy and adjuvant radiation as well as synchronous rectal cancer after neoadjuvant chemoradiation and abdominoperineal resection. As part of her treatment course, the patient received a total dose of 50.5 Gy pelvic irradiation and 60 Gy irradiation to the left breast and axillary basin. The patient was followed up with yearly computed tomography of the abdomen and pelvis in addition to yearly digital mammography. Her last mammogram, 5 months prior to presentation, was unremarkable. On physical examination, she had a hard, well-circumscribed, fixed mass in the upper, outer quadrant of her left breast. The lesion was not tender to palpation nor was there any associated axillary or supraclavicular lymphadenopathy. Examination of the nipple as well as the contralateral breast and axilla was unremarkable. Computed tomography of the thorax revealed a 6.7 × 4 cm mass arising from the left chest wall distinct from the left breast with extent to the pleural surface of the left thorax (Figure, A). Positron emission tomography revealed metabolic activity within the mass but did not reveal any distant disease. Core needle biopsy confirmed the diagnosis and the patient was offered resection with reconstruction.

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