Albert Van Amburg, MD, Chief Resident, Department of Medicine, The Jewish Hospital of St Louis: A 38-year-old premenopausal woman came to her private physician one month prior to hospitalization because of a mass in the right breast that was first noted two months prior to admission. Since the breast mass did not change in size during a complete menstrual cycle, she consulted her physician, who verified the presence of the mass, although the remainder of the physical examination findings were unremarkable. Mammograms suggested a malignant neoplasm because of small calcifications. Tissue obtained from an aspiration biopsy specimen of the lesion revealed a poorly differentiated adenocarcinoma, and the patient was hospitalized to initiate definitive therapy. A family history showed no evidence of carcinoma of the breast.
On admission, the patient was observed to be a well-developed, well-nourished woman; blood pressure was 120/ 85 mm Hg, pulse rate was 78 beats per