Welcome to Morning Session
PREPARED BY:
Dr. Bivek Shah, Dr. Tawhid Rahman Chowdhury�(Intern Doctors)�Department of Surgery�ABC Medical College
7th April, 2025
Case Presentation:
A 67 years old female presented with Lump in the Right Breast for 6 months.
PARTICULARS OF THE PATIENT:
Name: Mrs. Lutfur Nessa Khatun
Age: 67 years
Sex: Female
Address: Kajol Shah, Sylhet
Religion: Islam
Occupation: Housewife
Marital Status: Married
Date of admission:
20/03/2025
Date of examination:
20/03/2025
1. Lump in the Right Breast for 6 months
Chief Complaints:
According to patient statement, she was reasonably well 6 month back, then she noticed a lump in the Upper & inner quadrant of her Right Breast which was painless. The lump was initially small in size but gradually increasing in size.
She has no history of Fever, evening rise of temperature, cough, Trauma around breast. She has history of anorexia and weight loss
History of Present Illness:
On further query, she mentioned that she consulted with a doctor on 10th Nov, 2024, and after necessary clinical examination and investigation, she was diagnosed as a case of Carcinoma of Right Breast. Then she was advised for Chemotherapy & underwent 4 cycle of Chemotherapy with Epirubicin.
She has no history of yellow discoloration of skin, cough, chest pain, bone pain, headache, no any lump in other parts of body. Her bowel and bladder habit are normal.
History of Past Illness & Surgical History:
She has no any previous surgery history, no trauma history around breast�
History of concomitant medical illness :
She is Diabetic for last 14 years and Hypertension for last 4 months.�
Personal History :
She is Non-betel nut chewer, Non-smoker, Non- alcoholic
Family History:
She has 4 children & all were breast-feeded. �None of her relatives (1st degree) has such type of illness or any other associated disease. All of her family members are apparently healthy.�
Socio-economic History:
She belongs to middle class family.
Drug history:
∙ 4 cycle of Chemotherapy with Epirubicin�∙ Angilock 50 mg, Duocard 5 mg, Gensulin 30/70�∙ No history of taking OCP pill.�
Immunological History:
She is duly immunized against Covid 19. �EPI status – Unknown�
Menstrual History:
Menopause for last 12 years
Appearance: Anxious
Body built: Average
Co-operation: Co-operative
Decubitus: On choice
Anemia: Absent
Jaundice: Absent
Cyanosis: Absent
Dehydration: Absent
Edema: Absent
General Examination:
Clubbing: Absent
Koilonychia: Absent
Pulse: 88 b/min
Blood pressure: 130/90 mmHg
Temperature: 98.4 F
Respiratory Rate: 14 breath/min
Thyroid gland: Not enlarged
Bony Tenderness: Absent
Lymph node: Right axillary lymph node palpable which is non tender, approx. 2 x 1 cm in size, hard in consistency, mobile. All other accessible lymph node including Left Axillary lymph node was not palpable.
General Examination Continue:
INSPECTION:
Left breast:
Right breast:
Local Examination of Breast:
Local Examination of Breast:
PALPATION:
Left breast:
Right breast:
Abdominal Examination:
Abdomen is soft, non tender, no any palpable lump.�
Respiratory Examination:
Vesicular breath sound. No added sound.�
Cardiovascular System Examination:
S1 & S2 audible in all 4 areas. No murmur.�
Central Nervous System Examination:
GCS 15/15. All jerks are intact
Systemic Examination:
A 67 years old female, Diabetic, Hypertensive presented with complain of Painless Lump in Upper & inner quadrant of Right breast for 6 months, which was initially small in size, gradually increase in size.
No history of fever, cough & trauma around the breast.
On Examination, Patient is anxious, non anemic, non icterus, Right axillary lymph node palpable which is non tender, approx. 2 x 1 cm in size, hard in consistency, mobile. All other accessible lymph node including Left Axillary lymph node was not palpable
Salient Features:
Palpable lump present in Upper & inner quadrant of right breast which is non tender, irregular surface, ill defined margin, hard in consistency, not fixed with overlying skin & underlying structure.
Other systemic examination reveals normal.
Salient Features Continue:
Carcinoma of Right Breast with T1N1M0 (Post Chemotherapy)
Provisional Diagnosis:
A. Traumatic Fat Necrosis
B. Breast Tuberculosis:
Differential Diagnosis:
Points in Favour | Points Against |
Painless lump | No History of Fever, evening rise of temperature, Cough |
Points in Favour | Points Against |
Painless lump | No History of Trauma in Breast |
C. Fibroadenoma
Points in Favour | Points Against |
Painless lump | Old age Lump: Hard in consistency |
Investigation:
For Diagnosis:
For Staging:
For Prognosis:
For GA Fitness:
USG of Right Breast:
FNAC:
Histopathology:
Immunohistochemistry:
CBC with ESR:
Serum Creatinine, ALT:
Chest X ray P/A view:
Echocardiogram 2D:
Carcinoma of Right Breast with T1N1M0 (Post Chemotherapy)
Clinical Diagnosis:
Treatment Modalities:
A. Surgery:
B. Chemotherapy: Cyclophosphamide, Methotrexate, �5-fuorouracil, Epirubicin
C. Radiotherapy
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