Case 13

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Abstract
A 49-year-old female presented to the breast clinic for follow-up examination. Her mother died of breast carcinoma and her older sister had the same disease. She had already had a suspicious breast mass excised from the right side 4 years and another from the left side 11 years previously. The histologic diagnosis for both of the lesions was fibrocystic disease with moderate to severe ductal hyperplasia. In view of those changes and the patient's strong family history for breast cancer, periodic clinical follow-up had been recommended, which the patient faithfully followed. The examiner described bilateral breast nodularity, which was known to be present in the past. However, a “new and dominant” nodule was felt in the left upper outer quadrant. Mammogram was suspicious but was difficult to interpret partly because of extensive scarring from the previous surgery. Radiologic and scan studies were normal. Routine laboratory studies were within normal limits. No clinical hormonal syndrome or metabolic anomalies were detected. The mass was excised and the diagnosis of carcinoma was made. Biopsy was followed by a modified mastectomy with axillary lymph node dissection. Microscopic foci of residual carcinoma were found in the breast; the lymph nodes were negative for metastases. The patient was alive and appeared clinically well 16 mo after the last surgical procedure.
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