case presentation - carcinoma breast .pptx

case presentation

1. Case presentation Dr.G.Sai Sunayana DNB Radiation oncology First year resident Moderator – Dr.Sasikala P

2. Name: Mrs.L Age: 44 years Sex: Female Occupation: Field worker Residence: Bangalore Socioeconomic status: Upper middle class

3. Chief complaints: Chief complaints of lump in left breast since 6 months

4. History of present illness: She noticed lump in left breast 6 months ago, but left unnoticed, initially lump is of small pea size and gradually progressed to double of its size. Not associated with pain Not associated with nipple discharge Not associated with redness, bleeding, or ulceration No history of trauma

5. No history of fever, back pain, difficulty in breathing, cough, headache, abdominal pain or distension.

6. Past history : No history of similar complaints the past. History of hypothyroidism since 10 years and on thyroxine 88mg No history of diabetes milletus , hypertension, asthma, TB, CAD, CVA. History of LSCS

7. Menstrual and Obstetric history: Age at menarche – 12 years. Normal menstrual cycles with 28 day cycle, lasts for 3 days, normal flow, not associated with clots, not associated with pain. Last menstrual period: 27.08.2023 Age at marriage – 30 years Age at first child – 31 years P1L1A0D0 – Normal vaginal delivery, institutional delivery Breast fed for atleast 2 years No history of usage of oral contraceptive pills

8. Personal history: She is on mixed diet Sleep and appetite normal No history of loss of weight Bowel and bladder habits regular No history of habits Socioeconomic status – upper middle class (as per modified kuppuswamy classification)

9. Family history - Not significant Allergic history – no history of allergy to drugs

10. Summary: Mrs.L, 44yr old lady with obstetric history of P1L1A0D0, presented with complaints of lump in left breast since 6 months, not associated with pain or discharge with no significant past, personal and family history. Differential diagnosis: Malignancy of left breast Fibroadenoma Duct papilloma

11. EXAMINATION

12. General examination: Verbal consent taken and adequate privacy ensured She is conscious, coherent and oriented to time, place and person Moderately built and nourished ECOGPS – 1 Vitals : BP : 110/70 mm of Hg PR : 72 bpm SPO2: 98% with room air Temp: 98.4 F

13. General examination: Height : 160 cm Weight : 93.8 kg BMI : 36.6 kg/m2 BSA : 1.96 m2 No pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy and pedal edema .

14. Local examination : Verbal consent taken and examined in well illuminated room with adequate privacy Inspection: Bilateral breast are symmetrical Nipple areolar complex at same level Pendulous breast Right breast appears to be normal Skin over surface appears to be normal No scars, sinuses and engorged veins Right nipple areolar complex appears to be normal

15. Local examination : Inspection: Left breast – a single small lemon sized spherical mass at 12 to 1 o’ clock position just away from nipple areolar complex, skin over mass appears to be normal Left nipple areolar complex appears to be normal Scar is present at superior margin of mass No axillary masses in both the axilla No supraclavicular or infraclavicular fullness on both sides

16. Local examination : Palpation: On palpation of right breast: No local rise of temperature and no tenderness Right breast is normal On palpation of left breast: No local rise of temperature and no tenderness A single spherical mass palpated at 12 o’ clock to 1 o’clock position measuring about 2.5 x 2 cm, 2 cm away from nipple areloar complex, hard in consistency with irregular margins and irregular surface. Skin over surface is normal Fixed within breast tissue but not to pectoralis muscle or chest wall.

17. Local examination : Palpation: On palpation of right axilla no clinically palpable nodes Right supraclavicular and infraclavicular regions no clinically palpable nodes On palpation of left axilla No clinically palpable nodes Left supraclavicular and infraclavicular regions no clinically palpable nodes

18. Systemic examination: Per abdomen: Soft, non tender Pfannensteil incission present No abdominal distension No sinuses and engorged veins Hernial orifices are free No inguinal lymphadenopathy

19. Systemic examination: CVS: S1S2 heard, no murmurs RS: Normal vesicular breath sounds, no added sounds CNS: No focal neurological deficit

20. Summary: Mrs.L, 44yr old lady with obstetric history of P1L1A0D0, presented with complaints of lump in left breast since 6 months, not associated with pain or discharge. On examination, a single spherical mass palpated at 12 o’ clock to 1 o’clock position measuring about 2.5 x 2 cm, 2 cm away from nipple areloar complex, hard in consistency with irregular margins and irregular surface, no clinically palpable axillary, supraclavicular or infraclavicular nodes.

21. Provisional diagnosis: Malignancy of left breast –Carcinoma left breast TNM Stage : cT2N0Mx ( AJCC 8 th edition )

22. Investigations: MAMMOGRAPHY LEFT SIDE: A dense slightly irregular focal lesion is seen in upper quadrant of left breast measuring 2.4 x 2 cm at 12 – 1 o’ clock position. Few axillary lymphnodes are noted, largest measuring 2 x 0.8 cm with slightly increased cortical thickness and maintained fatty hilum. Suggestive of malignant lesion – BIRADS 5 (Highly suspicious of malignancy)

23. Trucut biopsy of left breast lump:

24. PETCT:

25. PETCT:

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