TUMOUR BOARD PRESENTATION case-1 AIIMS Bhopal.pptx

This is a tumour board presentation of AIIMS Bhopal conducted on 09/09/24. Contains a unique case of metastatic breast cancer with lesion in scapula

1. 13/09/2024 Metastatic Breast Carcinoma Tumor Board Discussion

2. History Case 2 35 years Premenopausal female (P0L0A0)- married with No Kids No h/o any addiction Family History- Not significant Chief Complaints- Feeling of Lump in Right Breast since January 2024 History of Present illness Feeling of lump in right breast which was gradually increasing in size not associated with Discharge and itching since January 2024

3. Clinical Examination No Comorbidity. Genoral Examination -conscious, well oriented to time place and person Temperature98 degree F, Pulse 77/minutes, BP 126/78 mmHg, SPO2- 97% on room air No pallor/Icterus/Cyanosis PS-1 No Systemic abnormality detected Breast Examination at Presentation initial diagnosis - 10 x 7 cm large lump palpable in right breast involving whole breast along with skin thickening, chest wall free , Axillary Examination- 2x 2 cm right axillary Lymph node palpable Left Breast& axilla- NAD, B/L SCF- NAD Breast Examination now- Scar mark present, NAD

4. Imaging CECT Thorax + Abdomen (07/03/2024)- 4.5 x 5 x 4.6 cm Well defined lobulated heterogeneously enhancing lesion predominantly in UIQ right breast along with few discrete enhancing subcm lesions in UOQ &ULQ largest - 0.6 cm, diffuse skin & NAC thickening. Multiple heterogeneously enhancing right axillary lymph nodes largest- 2.7 x 2.4 cm, Few subcm inter pectoral & Left axillary nodes. Diagnosed as Carcinoma Right breast, cT4b cN1 Mx, Clinical stage III C, TNBC Planned for 4 cycles of AC under Dept of Radiotherapy Received 3 cycles - last date Whole body F18 FDG PETCT (27/05/2024)- 2.7 x 1.7 cm metabolically active nodular soft tissue lesion UIQ of right breast, underlying chest wall muscle normal. Right axillary subcm nodes

5. HPR U/w BCS + AD on 21/06/2024 at AIIMs Bhopal Tumor Site- UQ Right side Size- 4 cm Histological type- Invasive Carcinoma of NOS(duct) Grade- Overall 2 (2+2+2=6) DCIS Present No Lymphatic and/or Vascular invasion Lymph nodes- 00/10 ypT2 ypN0 M0

6. Received 4th cycle of AC on 12/07/2024 under Dept of radiation oncology Ref. To Medical oncology after 4# Received 3 cycles of Pacli + Carboplatin 3 weekly from 02/08/2024 to 12/09/2024 under Medical oncology Whole body F18 FDG PETCT (03/2024)- 4 x 3 cm irregular mild metabolically active subtle patchy enhancing soft tissue component UIQ and UOQ of right breast(SUV max 2.3). Compared to previous CT mild increase in STM in Right breast. 3.6 x 2.4 cm post surgical collection right retromammary region Mild metabolically active skin thickening right breast with maximum thickness 1 cm (SUVmax 1.78).

7. Discussion Points Need Repeat Biopsy right breast lump Further Management Plan Team inputs

8. Conclusion Case summary Next steps