A 47-year-old woman presents to her ob/gyn with reports of fatigue, headache, general achiness, bloating, and what she describes as brain fog. She believes that she is in perimenopause and is seeking treatment for her symptoms.

Physical exam shows that she is pale, slightly jaundiced, and her abdomen is distended. Slight hepatomegaly is evident on palpation. There is an asymmetry between the left and right breasts, with the left one being larger and appearing swollen. It also feels somewhat denser than the other breast does, and the veins appear dilated. The patient does not find this remarkable because she breastfed all three of her children and said that she has experienced this asymmetry, along with calcifications in both breasts, for many years. Further examination reveals left axillary lymphadenopathy and a general swelling in the underarm area. The patient's medical history is otherwise unremarkable.