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Image of the Month—Quiz Case FREE

Gladys L. Giron, MD; Paul I. Tartter, MD
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Section Editor: Grace S. Rozycki, MD

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Arch Surg. 2004;139(3):341-342. doi:10.1001/archsurg.139.3.341.
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A 53-year-old woman of male genotype sought care at the emergency department with complaints of right breast swelling, erythema, mastodynia, and bilateral palpable breast nodules. The patient had undergone male-to-female sex change surgery more than a decade previously and developed female-looking breasts by using hormonal therapy but was dissatisfied with the results. She had had liquid silicone of unknown purity and manufacturer injected directly into both breasts illicitly 2 months before seeking care.

The patient's vital signs were stable, and she was initially afebrile. Physical examination revealed a markedly enlarged, tender, and indurated right breast. Bilaterally there were firm, mobile palpable breast nodules with no axillary adenopathy. She had been treated by her internist as an outpatient with multiple courses of oral antibiotics with no improvement. Computed tomography of the chest had been performed 1 week earlier, and a representative image is shown in Figure 1.

WHAT IS THE DIAGNOSIS?

A.Inflammatory carcinoma B.Cystosarcoma phyllodes tumor C.Silicone mastitis with abscess D.Extensive fat necrosis

Corresponding author: Gladys L. Giron, MD, St Luke's-Roosevelt Hospital Center, Division of Breast Surgery, 425 W 59th St, Suite 7A, New York, NY 10019 (e-mail: gladyslgiron@hotmail.com).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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