The Advantage of a Simple Palpation

1Emory University School of Medicine, Atlanta, GA
2Emory University School of Medicine, Atlanta, GA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 400

Case Presentation:

A 30‐year‐old white woman was seen in the preoperative clinic for basic labs and cardiac risk assessment. She was healthy until 4 months prior, when she developed weakness and double vision, for which she was seen by a primary care doctor and outpatient neurologist. She underwent a brain MRI that detected a 3‐cm clival mass. Because of increasing fatigue and poor appetite the patient's condition deteriorated, she also complained of back pain and poor memory. The neurosurgery team suspected a clival chordoma, and advised a resection of the mass. In the clinic she complained of weakness, nausea, vomiting, back pain, and poor concentration. During the exam she appeared tired, had dry oral mucosa, and left 6th nerve palsy; the right breast palpation detected hard round 2 × 3 cm nodule. The surgery was canceled, and she was admitted to the hospital for IVF and further evaluation. She had biopsy proven benign breast mass 15 years ago. She was aware of a new lump in her right breast and thought that it was a benign cyst. Laboratory data showed that she was in acute renal failure and had elevated serum calcium up to 16.9 mg/dL; thus, metastatic breast cancer was suspected and the patient underwent a diagnostic biopsy; the histology confirmed infiltrative ductal cell carcinoma. The image of the spine and a brain confirmed widespread metastatic disease through C, T, L spine, and a solitary large clival lesion. She was diagnosed with endocrine and HER‐2/neu receptor positive stage IV metastatic breast cancer. Serum hypercalcemia was corrected with vigorous IVF and bisphosphonate infusion. Her nausea and weakness has improved with symptomatic management, and she was discharged home with instructions to follow‐up with the oncology clinic for palliative chemo‐ and radiation therapy.


Breast cancer remains the leading cause of cancer death in women worldwide. Because of screening tools and availability of improved adjuvant therapies mortality has been declining in North America. Survival is greater in women younger than age 50 and for those with estrogen/progesterone‐positive as compared to estrogen/progesterone ‐negative tumors.


Early detection and treatment is imperative for surviving breast cancer. As a result, medical professionals should recognize careful breast palpation as an integral part of the physical exam.

MRI of the clival mass,

To cite this abstract:

Kobaidze K, Gilbert J. The Advantage of a Simple Palpation. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 400. Journal of Hospital Medicine. 2013; 8 (suppl 2). Accessed March 29, 2020.

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