Case study on fibroadenoma

Fibroadenoma is caused due to hormonal imbalance.

1. Case study on Anemia and Fibroadenoma : J. Anisha Ebens Pharm D VI yr

2. Introduction to anemia : Iron deficiency anemia is the most common type of anemia , and it occurs when your body doesn’t have enough of the mineral iron. When there isn’t enough iron in your blood stream, the rest of your body can’t get the amount of oxygen it needs. Causes: Loss of iron - heavy menstruation or pregnancy, poor diet or intestinal diseases affecting absorbtion of iron. Symptoms (moderate to severe): General fatigue, Weakness, pale skin, shortness of breath, Dizziness, strange cravings to eat items that aren’t food, such as dirt, ice, or clay, a tingling or crawling feeling in the legs, tongue swelling or soreness, cold hands and feet, fast or irregular heartbeat, brittle nails, headaches. Diagnosis: RBCs, WBCs, Hemoglobin , Hematocrit , Platelets. Treatment: Iron tablets can help restore iron levels in your body, Diet, In the most severe cases, a blood transfusion can replace iron and blood loss quickly.

3. Introduction to fibroadenoma : Fibroadenomas of the breast are benign tumors characterized by an admixture of stromal and epithelial tissue. Since both fibroadenomas and breast cancer can appear as similar lumps, it is currently recommended to perform ultrasound analyses and possibly tissue sampling with subsequent histopathologic analysis in order to perform diagnosis. Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges. Signs and symptoms : lump of mass which is usually movable. Cause : hormone related. Diagnosis : It is diagnosed by FNA, ultra sound, mammogram. Treatment : Surgery or hormone balance. Mostly it will not recur, but in some cases it may recur again.

4. Ms. S 15 yr old female patient was admitted in the hospital ( 16.08.2018), C/O : Mass in left breast x 1yr, no pain, no discharge, no redness – outpatient. Increase in size gradually. Itching in perineural region. 19/8- Cough with expectorency , running nose, throat pain, difficulty in breathing, nausea. H/O : Swelling in Lt breast, gradual onset, progressive in nature, attained present size, itching in nipple. No H/O of discharge in nipple, wt. loss, fever. Case study:

5. Personal history : menstrual H/O- irregular periods for the past 6 months, 2 months once- 3 to 4 days, increased passage of clots. O/E : Pallor, consious , oriented. BP: 110/80, Pulse: 80/min. Lab investigations : Blood group B(+) ve Parameter Report Value Normal value Hb 8.4 on 16.8 5.4- As out patient 12-16g/dl TLC 8.1 4500 – 11000 cells/mm³ Platelets 5.34 1.5 – 3.5 lakhs /mm³ PCV 20.8 36.0-46.0% Urea 9 8-25mg/dl Creatinine 0.37 0.6-1.5mg/dl

6. Other investigation : FNA left breast- benign breast disease, Serology- negative Left breast- firm, nodule in upper medial quadrent - 5x3cm, non tender. Impression : 5x3cm nodule in breast, microcytic hypochromic anaemia. Diagnosis : Iron deficiency anaemia, Fibroadenoma , 20/8- URI. Plan : To improve the Hb levels and then do surgery.

7. Started with blood transfusion on 17.08.2018. After 1 unit of blood transfusion Hb - 10.5 g/dl

8. Treatment chart : As out patient: T. LIVOGEN -BD x 15 days T. PAN -BD x 15 days Drugs Dose R.O.A. Freq. No. Of Days 17 18 19 20 21 22 T. ALBENDAZOLE 400mg P/O Stat T. LIVOGEN 1 tab P/O 0-1-0 T. LIMCEE 500mg P/O 0-1-0 T. AZITHROMYCIN 500mg P/O OD SYP. ASCORIL 7.5 ml P/O BD T. AUGUMENTIN 625mg P/O 1-0-1 T. CETIRIZINE 5mg P/O 0-0-1 CAP. MUCOLITE SR 75mg P/O 1-0-0 SYP. CHERICOF 10ml P/O SOS

9. Pre operative treatment ( 22.08.2018): Inj. TT Inj. XYLO (test dose) Inj. TAXIM Operation on 23.08.18. Discharge summery : Adviced to continue T.AUGUMENTIN, CAP. MUCOLITE SR, SYP CHERICOFF. Adviced to take more iron rich foods. Pharmacist intervention : There is no drug interactions.

10. SOAP notes: Subjective - A 15 yr old female patient was admitted in the hospital on 16.08.2016. Objective - Mass in left breast x 1yr, no pain, no discharge, no redness. Gradual increase in size. No H/O wt. loss, discharge from nipple. Assessment - Impression: 5x3cm nodule in breast, microcytic hypochromic anaemia. Diagnosis: Iron deficiency anaemia, Fibroadenoma , 20/8- URI. Plan - T. ALBENDAZOLE, T. LIVOGEN, T. LIMCEE, T. AZHITHROMYCIN, SYP. ASCORIL, T. AUGUMENTIN, T. CETIRIZINE, CAP. MUCOLITE SR, SYP CHERICOFF.