Fakhra bibi CA breast yauaushhaajsis.pptx

pancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation pancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuwpancreatic pseudocyst presentation 1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuw1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuw1.pptxywyqiwisjhshahajwjsusuusususususususususuusususuwuwuuwueusueysueyeusuwuwuuwuwuwuwuwuwuwuwuwuwuuw

1. CA Breast Dr Abdul Haseeb Postgraduate Resident King Edward Medical University West Surgical Ward Mayo Hospital

2. B iodata ; Pt.Name : Fakhra Bibi Age/Sex : 40/F House wife Resident of okara Married Children : 4 No hs of weight los s Family Hx of breast cancer In mother and sister.

3. Hx: Patient has history Papillary carcinoma of Rt breast in 2021 for which she underwent Mastectomy back in November 2022 from a private setup. Recurrence occured in 2024 No Hx of Vomiting,Fever or decrease oral intake. She received 4 four cycles of chemotherapy. (8/5/24- 18/7/24) Hx of RHEUMATIC HEART DISEASE

4. Examination; Rt breast On inspection,There is a scar mark present of previous surgery. No mass palpable, no skin discharge, no erythema No skin change Rt Axillary nodes – ve Left sided breast exam unremarkable.

5. Image; Medial Lateral Superior

6. INVESTIGATIONS: Trucut Biopsy (24/3/24);(KEMU) TRUCUT BIOPSY-RIGHT BREAST:INVASIVE BREAST CARCINOMA GRADE Il Receptor Status (Mughal Lab): (19/4/24) ER – ve PR – ve Her 2 neu – ve

7. CT CAP e Contrast( 4/5/24); (Pre chemo) Comparison made with CT dated 31-8-2023. K/C of right breast papillary carcinoma. Status right mastectomy 2022. No chemo/radiotherapy CHEST: In comparison to previous CT there is increase,in size of lobulated heterogeneously enhancing soft tissue density lesion now measuring approx 4.7 x 4.9 x 4.5 cm (CC X TR X AP) (previously measured 15x15mm at right mastectomy site, with_infiltration into underlying pectoralis major muscle. Another similar characteristics nodule is noted subjacent to the above mentioned lesion measuring approx 17 x 16mm.

8. Overlying parenchyma thickness increased measuring 17mm, Few sentinel enhancing nodules noted largest measuring 12mm previously measuring approx 6mm. No ipsilateral lymph adenopathy seen. Contralateral breast parenchyma and axillary region appear unremarkable No lung parenchymal nodule seen B/L small axillary lymph nodes are seen Largest abnormal shaped node on Rt side (level II) Measures 12×11 mm. Left axillary lymphnode have Preserved fatty hilum largest measuring 14mm. Few timy intraparenchymal soft tissue nodules are seen largest measuring 2.8mm in Rt lower lobe. Few small volume mediastinal lymph nodes seen.

9. ABDOMEN AND PELVIS : Few enhancing para aortic and mesenteric lymph nodes seen, largest measuring 15x 12mm in left para aortic region. Well defined homogenously enhancing rounded mass lesion measuring approx 2.9 x 2.6 cm is seen in right lateral uterine wall likely a fibroid. Visualised slices through skeletal system is grossly unremarkable. Impression (01 March 2024 – 14:24 PM): In comparison with previous CT there is relative progression in disease process by virtue of increase in. size of lesion in biopsy proven and operated case of right breast papillary carcinoma

10. BONE SCAN 6/4/24: Prechemo NO SCINTIGRAPHIC EVIDENCE OF METASTATIC DEPOSITS IN BONES.

11. CT CAP 5/8/24 : Post chemo Chest : Few atelectatic bands are seen bilaterally. Few small non-specific 5 mm nodule is seen in subpleural location in anterior segment of left lower “ lobe. An 8x7 mm small nodule is seen in right peri-hilar region. No mediastinal or hilar lymphadenopathy seen. No evidence of pleural effusion seen on either side.

12. Abdomen and pelvis: Liver measures 16.4 cm normal in size. No focal lesion is seen. No intrahepatic biliary dilation seen. . CBD and portal vein are normal. ⁃ Gall bladder, pancreas and spleen (10.6 cm) appear unremarkable Both kidneys and adrenal glands appear unremarkable. No significant Iymphadenopathy or ascites noted. imaged bowel structures appear unremarkable. ⁃ Right adnexal well defined enhancing lesion of 30x28 mm is seen. imaged sections through bones and spine show degenerative changes. No evidence of definite lytic or sclerotic lesion noted

13. IMPRESSION : S/P right mastectomy for papillary CA of right breast. Multiple pulmonary nodules. No residual /recurrent mass seen in right anterior chest wall. Follow up and comparison with previous studies are suggested

14. Post Chemo Echo RHIEUMATIC HEART DISEASE. MODERATE MITRAL REGURGITATION. NORMAI SIZED LEFT VENTRICLE WITH good SYSTOLIC FUNCTION.

15. Bone scan 9/8/24 : (Post chemo) Bone Scan shows focal areas of abnormal increased uptake of radionuclide in L-4 vertebra and right sacroiliac joint. Feet, may
Increased and non homogenous uptake of radionuclide is also seen in both knee joints and be due to arthritic changes.

16. Plan?????