Rsabbasi (1)

1
(No Transcript)
2
CASE STUDY

Presenter Dr. rabia sehar abbasi Pgt surgery
UNIT III
3
TABLE OF CONTENTS
1. CASE STUDY PATIENT PRESENTATION
2. INVESTIGATIONS AND RADIOLOGY
3. DISCUSSION

4
CASE HISTORY

• PATIENT PROBLEM
• A 44yrs-OLD WOMAN,MARRIED FOR 25YRS, RESIDENT OF
  JAMSHORO, CAME HERE THROUGH OPD ON 4-10-19 WITH
  COMPLAIN OF A PAINLESS LUMP IN HER RIGHT BREAST
  FOR LAST 4 MONTHS.LUMP WAS INSIDIOUS IN ONSET AND
  RAPIDLY PROGRESSIVE FROM LEMON TO TENNIS BALL
  SIZE.
• SHE HAS NO ANY HISTORY OF
• TRAUMA.
• NIPPLE DISCHARGE
• FEVER OR WEIGHTLOSS OR COUGH.
• CONSTITUITIONAL SYMPTOMS
• SHE IS NON HYPERTENSIVE AND NON DIABETIC.

5
HISTORY
P50, all NVD First child At age of 20yrs Last
child is 15yrs old No Hx of Abortion or
miscarriage
NO Tuberculosis Hx NO CHEMOTHERAPY OR RADIATION
HISTORY NO DRUG ALLERGY Hx NO OCP OR HRT Hx
6
LOCAL EXAMINATION

• A hard normothermic, slightly tender mass about
  44cm involving central region of right breast.
• Nipple is circumferentially retracted with no
  discharge.
• Areaola shows eczematous and ulcerative changes
  with skin of whole breast seems to be peaud
  orange appearance.
• Right sided Anterior and central axillary lymph
  nodes are palpable.
• Other relevant systemic examination status is
  normal

7
LABORATORY INVESTIGATIONS

• Hb 10.6 mg/dl
• WBC 8.4 X 103
• PLT 441 X 109
• LFT Within normal range
• CREATININE 0.7 mg/dl

8
RADIOLOGICAL IMAGING FOR DIAGNOSIS

• MAMMOGRAM
• RIGHT-SIDED SHOWS EXTENSIVE ASSOCIATED BRANCHING
  CALCIFICATIONS THOUGHT TO REPRESENT DCIS.
• LEFT SIDED IS NORMAL WITH NO SIGNIFICANT PATHOLOGY

9
HISTOPATHOLOGY

• TRUCUT BIOPSY OF RIGHT BREAST SHOWS FEATURES ARE
  CONSISTENT WITH INFILTRATION DUCTAL CARCINOMA OF
  BREAST, GRADE II .

• THE ESTROGEN RECEPTORS, PROGESTERONE RECEPTORS
  AND HER 2 neu ARE NEGATIVE.

10
RADIOLOGICAL IMAGING FOR STAGING

• CT SCAN CHEST WITH CONTRAST
• SOFT TISSUE DENSITY LESION OF ABOUT 2.11.82.1cm
  WITH SPICULATED OUTLINE IN UPPER OUTER QUADRANT
  OF RIGHT BREAST ,NIPPLE APPEARS NORMAL. FEW LYMPH
  NODES ARE SEEN IN RIGHT AXILLA, ONE OF THEM
  MEASURES ABOUT 1.31.7cm. MILD SPONDYLOTIC
  CHANGES ARE SEEN IN SPINE.

11
RADIOLOGICAL IMAGING FOR STAGING

• SKELETAL SCINTOGRAPHY
• IS NEGATIVE FOR ANY BONY METASTASIS.

12
PROVISIONAL DIAGNOSIS OF CASE
A 44YRS POSTMENOPAUSAL LADY WITH INFILTRATING
DUCT CELL CARCINOMA RIGHT BREAST CLINICAL STAGE
2 T2,N1,MO
13
(No Transcript)
14
MANAGEMENT AND TREATMENT PLAN
AT THIS POINT, WHAT TREATMENT WOULD YOU
RECOMMEND? HALL IS WELCOME FOR DISCUSSION !
15
THANK YOU !