A 46-YEAR-OLD previously healthy woman was seen for a rapidly enlarging right breast mass. She had been told many years before that she had a right breast "cyst," and the size had evidently not changed until the past 8 to 12 weeks. The patient denied a history of familial breast disease, left breast disease, or nipple discharge. Physical examination demonstrated venous engorgement in the skin of the right breast and a 15 × 10-cm firm, nontender, movable mass (Figure 1). There were no other skin changes, no fixation to the chest wall, and no palpable axillary nodes. Fine-needle aspiration of the right breast mass demonstrated multiple fragments of stroma with marked atypia.
A. External beam radiation therapy with 50 Gy in 20 fractions
B. Induction chemotherapy with cyclophosphamide and doxorubicin
C. Total mastectomy
D. Tamoxifen 10 mg, twice daily
David V. Feliciano. Image of the Month. Arch Surg. 2001;136(4):475. doi: