Skill Checkup: A 64-Year-Old Woman With a Breast Mass and Back and Hip Pain

Maurie Markman, MD

Disclosures

September 08, 2021

Correct Answer: A. Breast cancer

Breast masses are a common clinical finding and may be palpable or nonpalpable, benign or malignant. The majority of palpable breast masses are benign, but some women who present with this finding will have a diagnosis of cancer. This patient has not only a mass but also "suspicious" axillary nodes, as well as an elevated alkaline phosphatase level — findings associated with metastatic breast cancer.

Fibroadenomas are more common in younger patients. These are benign tumors composed of stromal and epithelial elements. Multiple or complex fibroadenomas may indicate a slightly increased risk for breast cancer. The relative risk for breast cancer in patients with such fibroadenomas is approximately twice that of patients of similar age without fibroadenomas. Fibroadenomas may be excised, especially if they grow or change the shape of the breast. Sometimes, however, these tumors stop growing or even shrink on their own without treatment.

Phyllodes tumors of the breast are rare, accounting for less than 1% of all breast tumors. They are most common in women in their 40s. On a mammogram, this type of tumor may appear similar to a fibroadenoma. Phyllodes tumors tend to grow quickly, but they rarely metastasize outside the breast. Whether phyllodes tumors are benign, borderline, or malignant, the treatment is the same: surgery to remove the tumor.

A radial scar is a star-shaped breast mass that may be benign, precancerous, or contain a mixture of tissue, including hyperplasia, atypia, or cancer. However, radial scars tend to be a discrete tumor without metastasis. They are removed surgically.

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