TY  - JOUR
T1  - IMage of the month—quiz case
AU  - Harish KK, Madhu YC
Y1  - 2012/07/01
N1  - 10.1001/archsurg.2011.907
JO  - Archives of Surgery
SP  - 679
EP  - 679
VL  - 147
IS  - 7
N2  - 
A 60-year-old woman presented with an irregular lesion in the skin over the midline of her chest of 3 months' duration (Figure 1). There was recent onset of pain. The patient had undergone coronary artery bypass surgery 8 years earlier. On examination, we found an irregular-shaped nodular lesion, with some areas of ulceration measuring 10 cm vertically and 5 cm horizontally. There was restricted mobility of the lesion over the sternum. The single axillary node was palpable in both axillae and measured 3 cm× 3 cm on the right side and 2.5 cm × 2.5 cm on the left side. Supraclavicular nodes were not palpable, and there were no clinical or radiologic signs of metastasis elsewhere. A computed tomographic scan of the chest with contrast revealed the lesion in the midline extending to both breasts but more evident on the right side (Figure 1). The sternum was not involved with the disease; however, a biopsy revealed moderately differentiated carcinoma (Figure 2A). Immunohistochemistry was performed to confirm the diagnosis of breast cancer. Immunohistochemistry was positive for CK7, CK20 (Figure 2B and C), and gross cystic disease fluid protein positive (Figure 2D).

SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2011.907
UR  - http://dx.doi.org/10.1001/archsurg.2011.907
ER  -