Case history
Case history #1
A 65-year-old white woman undergoes a routine screening mammogram, which demonstrates a cluster of pleomorphic microcalcifications that are located in the upper outer quadrant of her left breast. One year ago, her mammogram showed no abnormalities; the patient has been diligent in undergoing annual mammograms because her mother was diagnosed with breast cancer at the age of 50 years.
Case history #2
A 68-year-old white woman presents to her physician with a 3-month history of a painless firm lump in the upper outer quadrant of her breast. During a clinical examination, her physician notes the lump is 20 mm at its widest. Her physician also notes that she has 3 enlarged ipsilateral axillary lymph nodes.
Other presentations
Inflammatory breast cancer is an aggressive form of invasive breast cancer that is diagnosed clinically by the rapid (days to weeks) onset of redness, warmth, tenderness, and peau d'orange of the involved breast, frequently in the absence of a dominant breast mass.[4] While these findings may also be found in patients with mastitis, inflammatory breast cancer may be differentiated from mastitis by the absence of fever, leukocytosis, and response to antibiotics.
Classically, the biopsy of the affected area in inflammatory breast cancer demonstrates dermal lymphatic invasion by tumor cells.[5] Most patients with inflammatory breast cancer have nodal involvement at presentation, and approximately one third of these patients have distant metastases.
Paget disease of the breast is characterized by the development of an eczematous lesion involving the nipple of the breast, which gradually ulcerates if left untreated.[6] Biopsy of the site reveals malignant, intraepithelial adenocarcinoma cells within the epidermis of the nipple.[Figure caption and citation for the preceding image starts]: Peau d'orangeFrom the collection of Dr Amal Melhem-Bertrandt; used with permission [Citation ends].
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