Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Locally Advanced Breast Carcinoma Clinical Examination Discussion and Treatment
wife from Pattabiram belonging to low
socioeconomic class presenting with
the chief complaints of painless lump
in the left breast for past 6 months .
HISTORY OF PRESENTING ILLNESS
Patient was apparently normal 6 months
back after which she noticed a lump in
the left breast
-insiduous in onset ,
- progressive,
initially small in size
gradually increased and attained the
current size
not associated with
pain
No h/o nipple discharge
No h/o recent onset of nipple retraction
No h/o fever/trauma
No h/o loss of weight
No h/o loss of appetite
No h/o bone pain
No h/o difficulty in breathing
No h/o cough with hemoptysis
No h/o jaundice/abdominal
pain/distension
No h/o headache/blurring of
vision/seizures
No h/o swel ings elsewhere in the body
PAST HISTORY
No h/o DM,HT,asthma,tuberculosis,
epilepsy,jaundice,IHD.
No h/o previous hospitalization
No h/o previous surgeries.
No h/o previous irradiation.
No h/o intake of OCPs
PERSONAL HISTORY
Consumes non vegetarian diet
Normal bowel and bladder habits
No h/o additive habits
MENSTRUAL AND MARITAL
HISTORY
Age at menarche :13 years
Age at marriage : 17 years
Age at first child birth : 19 years
2nd child : 20 years
3rd child : 22 years
breastfeeding done for all children till 10
months
Age at menopause : 44 years.
No h/o hormone replacement therapy.
FAMILY HISTORY
No h/o breast/gynaecological/
gastrointestinal malignancy in first
degree relatives.
GENERAL EXAMINATION
patient is conscious
oriented
well built and nourished
No pallor
No icterus
No cyanosis
No clubbing
No pedal edema
No significant generalised lympadenopathy
VITAL SIGNS
PR-76/min,regular in rhythm,normal
volume,no specific character,no
radiofemoral, radioradial delay,equally felt
on both sides in all palpable peripheral
vessels ,no vessel wall thickening
RR-18/min, thoracoabdominal type
BP-130/80 mm Hg in right upper limb,sitting
posture
Afebrile.
LOCAL EXAMINATION
After getting consent from the patient and in the
presence of a female attender, the patient is
stripped upto waist.
EXAMINATION OF LEFT BREAST
Examined in sitting posture with arms by the side,
arms raised above the head, arms at hip,
leaning forward, and supine posture under
bright light
INSPECTION
[Arms by the side]-left breast is slightly higher than
the right breast,fullness is noted in the upper
outer quadrant of breast,
skin over the lump is normal,
No peau d'orange appearnance
no ulcers, nodules, fungation and dilated veins
No dimple/puckering seen
Nipple :
size 1*1 cm, centrally placed
Left nipple is slightly higher than right nipple
no retraction of nipples
no discharge from nipples
no ulcers, cracks, fissures
Areola ;
size 4*4cm, brown in colour
circumferential ,no cracks ,fissures and
ulcerations
Arms and thorax : no edema, no visible
nodes/ful ness
Axil a : no visible nodes
Supraclavicular fossa : no ful ness
ON RAISING ARMS ABOVE HEAD
Both breast move equally
Undersurface of the breast appears normal
No peau d'orange /dimpling/puckering
No retraction of nipple
ON LEANING FORWARDS
Breast fall equally on both sides.
ON CONTRACTING PECTORALIS MAJOR BY
KEEPING HANDS AT HIP
The lump does not become prominent
PALPATION
Not warm,not tender.
Lump of size 7*5 cm hard in consistency,
ovoid in shape, wel defined margins,
irregular surface, felt in the the upper outer
quadrant, fixed to the breast tissue
Skin over the lump is pinchable
The Lump moves along with breast tissue
on contracting and relaxing the pectoralis
major there is no restriction of mobility
along the line of muscle fibres
No fixity to chest wall
Nipple : no palpable mass deep to the nipple
no discharge from the nipple
Examination of axilla: A single node is
palpable behind the anterior axillary fold,
1*1 cm ,which is firm in consistency ,mobile
and skin is pinchable with normal skin
surface
no other lymph nodes palpable.
Supraclavicular fossa:No nodes palpable
Examination of right breast :normal
Examination of right axilla :normal.
Examination of right supraclavicular fossa :
normal
Percussion
Resonant note felt over parasternal
areas
OTHER SYSTEMS
Examination of abdomen : soft,not tender, no
palpable mass,no organomegaly,no free fluid,hernial
orifices are free,external genetalia normal.
Examination of RS : Normal vesicular breath sounds
heard. No added sounds
Examination of CVS:S1 S2 heard,no murmurs
Examination of CNS:No focal neurological deficit
Examination of Spine and Cranium:Normal
Per rectal examination- to be done
Per Vaginal examination- to be done
DIAGNOSIS
CARCINOMA of left BREAST ? T3 N1 Mx
(STAGE I IA).
MANAGEMENT
INVESTIGATIONS
Routine:
Blood: TC, DC ,ESR,Hb%, Blood
grouping/typing,urea,sugar,creatinine.
Urine: sugar,albumin,deposits
X ray chest
ECG
Specific : Mammogram
FNAC , core needle biopsy
Staging investigation: chest x-ray
USG abdomen
liver function test
x-ray skul ,pelvis,spine
mammogram of
contralateral breast
CT chest
CA 15-3/CEA
TREATMENT
1.Neoadjuvant chemotherapy-
downstage the tumour+Modified
radical mastectomy in the left breast
+ adjuvant chemotherapy +
radiotherapy
.
This post was last modified on 08 August 2021