A 38-year-old woman who had been well all her life walked into an emergency department with a painful red lump in her left breast, about five centimeters across, firm and mobile. She was not breastfeeding. She felt otherwise fine. The team suspected an abscess, one of the most routine problems in breast surgery, and sent her home with antibiotics.
A week later she was back, no better. She was referred to general surgery, and during the operation to treat what everyone still assumed was an abscess, the surgeon found something else inside the cavity: a hard lesion with a necrotic center. Biopsies were taken. The pathology came back as metastatic large cell neuroendocrine carcinoma.
