A 35-year-old woman was seen in the endocrinology clinic because of recurrent goiter and breast cancer. Micronodular lesions on the gingiva and tongue were observed. Diagnostic testing was performed.

A 48-year-old woman presented after routine tomosynthesis had revealed a lesion in the left breast. Core-biopsy and lumpectomy specimens showed ductal carcinoma in situ, with positive margins. Management decisions were made.

A 60-year-old woman was admitted to this hospital because of gradually progressive painful muscle spasms, weakness, and hyperreflexia in the legs. Brain and spine imaging revealed no parenchymal abnormalities. A diagnostic test was performed.

A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.

Presentation of Case

Dr. Susan K. Mathai (Internal Medicine): A 63-year-old woman was admitted to this hospital because of rapidly progressive respiratory failure.

The patient had a history of Poland syndrome (agenesis of the right breast, pectoralis ...

A 49-year-old woman presented with a 12-cm mass in the right breast, fixed to the chest wall. The overlying skin was erythematous and edematous. A core-biopsy specimen showed infiltrating ductal carcinoma.

An 85-year-old woman had poorly differentiated invasive ductal cancer (positive for estrogen and progesterone receptors and HER2) with no clinical evidence of lymph-node or distant metastases. She had hypercholesterolemia, hypertension, chronic obstructive pulmonary disease, hypothyroidism, arthritis, and a history of pleural and pericardial effusions of unknown cause. She lived with a daughter and performed all activities of daily living. A management decision was made.

A 36-year-old woman was seen in the multidisciplinary breast cancer clinic of this hospital for management of hormone-receptor–positive breast cancer. She had a 1.4-cm, grade 2 of 3, infiltrating ductal carcinoma that was positive for estrogen-receptor protein and progesterone-receptor protein and negative for human epidermal growth factor receptor type 2, with micrometastases to 1 of 13 axillary lymph nodes detected by immunohistochemical analysis. A management decision was made.

A 47-year-old premenopausal woman came to this hospital for treatment of breast cancer. A mass that measured 5 cm in diameter was present in the left breast; needle biopsies showed infiltrating ductal carcinoma that was grade 2 of 3, hormone receptor–positive, HER2/neu-negative. An evaluation of the staging disclosed a solitary lesion in the T6 vertebral body, which was asymptomatic. A management decision was made.

A 62-year-old woman with a history of breast cancer was found to have a mass in the contralateral breast on magnetic resonance imaging performed for follow-up of the first cancer. Excision of the mass and examination of the biopsy specimen showed infiltrating and in situ ductal carcinoma, grade 3 of 3, positive for human epidermal growth factor receptor 2. Options for management are discussed in a multidisciplinary setting.

A 38-year-old woman came to the Gastrointestinal Cancer Genetics Clinic of this hospital because of a family history of breast and gastric cancer. Her mother had died of gastric cancer, and her maternal aunt had bilateral breast cancer and died of gastric cancer. Screening upper gastrointestinal endoscopy had been negative in the patient. A diagnostic procedure was performed.

A 56-year-old woman had dizziness and nausea, followed by slurred speech and ataxia; 2 months later she was unable to walk. Neurologic examination disclosed severe ataxia. Imaging studies of the brain did not show discrete parenchymal lesions or vascular occlusion; there was cerebellar atrophy. A diagnostic procedure was performed.

A 71-year-old woman with the recent onset of urinary incontinence was found to have bilateral adnexal masses in the pelvis and a mass in the bladder. A diagnosis of transitional-cell carcinoma was made, and treatment with cystectomy and chemotherapy was advised. The patient sought a second opinion. She had been well except for a history of carcinoma of the breast 22 years earlier. A diagnostic procedure was performed.

A 56-year-old woman with a 1-cm invasive ductal carcinoma of the breast came to a multidisciplinary breast clinic for advice on management. A lumpectomy and axillary dissection disclosed a small focus of metastatic tumor in a sentinel lymph node. The staging and management of breast cancer with sentinel lymph-node involvement are discussed.

A 58-year-old woman with cancer detected on mammography chose to undergo breast-conserving therapy. The tumor expressed estrogen and progesterone receptors and lacked HER2/neu amplification. The authors discuss management options for early-stage breast cancer, and new techniques that may help clinicians select optimal therapy.

Presentation of Case

A 51-year-old, premenopausal woman came to this hospital with a newly diagnosed breast carcinoma and a strong family history of breast cancer.

Three months earlier, on physical examination at another institution, a mass in the upper ...