CASE PRESENTATION-IRREGULAR BREAST LUMP.pptx
- 1. CASE PRESENTATION- IRREGULAR BREAST LUMP • DR.HASSAN ZAMIR AHMED • 1ST YEAR PGT
- 2. HISTORY • Mrs.XYZ ,40 Year old,Hindu lady ,Resident of Budge Budge,Home maker • Chief Complaints- • Swelling in right breast x 4months • Ulceration and pain over swelling in right breast x 2weeks
- 3. HISTORY OF PRESENTING ILLNESS • She noticed the swelling of approx 2cm in right breast 4 months back • Rapidly progressed to current size of approx 10cm • Not associated with pain or fever • 2months later another swelling appeared in right axilla of about 1-2cm in size • Gradually increasing in size • No other swelling in opposite breast or axilla.
- 4. Cont. • She developed an ulcer in the nipple areolar complex 2 weeks back just above the swelling • Ulcer was associated with serous discharge • It was also associated with pain • Pain was localised to regions of ulcer,sudden in onset,dull aching in character,relieved on taking medication,no aggravating factors
- 5. cont. • No h/o nipple discharge • No h/o trauma/radiation exposure in the past • No h/o chest pain, cough • No h/o loss of weight or appetite • No h/o pain in abdomen or jaundice • No h/o lower back ache ,pain in limbs • No h/o headache/vomiting or weakness of any limbs • No history of Diabetes, hypertension/ hypothyroidism
- 6. PAST HISTORY • No h/o similar complaints in the past • No past h/o tuberculosis • No past h/o surgical intervention
- 7. FAMILY HISTORY • No h/o breast, ovarian, prostate or GI malignancies in 1st degree relatives or family members.
- 8. MENSTRUAL AND OBSTETRIC HISTORY *Menarche at the age of 12 years *Married at age of 16 years *1st child at age of 23 years Youngest child of age 5 years * 4 children *All breastfed for minimum 2 years *No h/o intake of any birth control pills *Has normal menstrual cycles
- 9. PERSONAL HISTORY *Diet-Vegetarian *Normal sleep pattern *Normal bowel and bladder habits *Non smoker/non alcoholic *No known allergies
- 10. To summarize…. • 40 year premenopausal lady presented with rapidly progressing swelling in her right breast for 4 months which is at present of approx. 10 cm and a ulcer over the swelling for the last 2 weeks associated with serous discharge. • She complained of another swelling in her right axilla for last 2 months • Negative metastatic and family history.
- 11. General Physical Examination *Conscious,oriented to time, place and person *Built-average *Performance status-90(Karnofsky scale) *Well hydrated *BMI-24.1kg/m2 *No pallor,icterus,clubbing,cyanosis,pedal edema *Generalised lymphadenopathy – *Regional Lymphadenopathy + Vitals- *BP-120/80 mm of mercury,PR-80bpm,RR-24/mint, temp-afebrile
- 12. LOCAL EXAMINATION • Inspection-Asymmetry noted with right breast lying at a higher level • Visible fullness in right upper outer quadrant • Shiny, engorged veins, peau d’ orange present • An ulcer present over the swelling of size 1X1cm in UOQ involving nipple areoler complex,irregular in shape,everted edges and floor with pale necrotic tissue • serous discharge present
- 13. • On leaning forward the left breast fell more forward • B/L NAC - no nipple discharge. • Right NAC was approx. 3cm higher then left ,distorted & nipple retracted. • Right nipple involved in the ulcer.
- 14. • On raising both the arms above head-right nipple retracted and peau d’orange becomes more prominent • Axilla,arm and thorax appears normal
- 21. Differetial diagnosis • Phylloides sarcoma • Plasma cell mastitis • Tuberculosis breast • Antibioma • Chronic fat necrosis
- 22. Thank you