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Case presentation

Case presentation. DR.AHMED KENSARAH. History. This is a 60 year old Saudi lady. known case of HTN Hypothyroidism RA C/O Left large ulcerating breast mass. History. History of present illness Lt breast lump 6 years ago Ignored in last 1 year. The mass increased in size

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Case presentation

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  1. Case presentation DR.AHMED KENSARAH

  2. History This is a 60 year old Saudi lady. known case of • HTN • Hypothyroidism • RA C/O Left large ulcerating breast mass.

  3. History History of present illness • Lt breast lump 6 years ago • Ignored • in last 1 year. • The mass increased in size • Bloody nipple discharge • Skin changes • Fungating Ulcer

  4. History • No Family history of breast cancer • No history of benign breast disease or biopsy • No history of smoking.

  5. History • Age of menarche: 14 • Age of menopause : 50 • She had her 1st child birth at 30 years of age • No History of OCP

  6. Systemic Review unremarkable • Past Surgical History Lateral anal sphincterotomy 2 years back • Allergies -ve • Medication • Thyroxin • Mobic • Capotin

  7. Physical Examination Vital signs CVS Unremarkable Chest Abdomen

  8. Breast Examination • Right breast Normal with free axilla • Left breast Enlarged Red Edematous Fungated ulcer Bloody discharge

  9. Left breast Firm Hot Tender Left arm swelling No axillary LN

  10. Investigation Blood work: • CBC • U&E NORMAL • LFT • Serum Calcium

  11. Investigation Radiological • Mammogram • Left breast : was not done . • Right breast : Benign prominent ducts.

  12. Investigation Ultrasound : • Left : • Whole Left breast parenchyma was involved • single hypoechoic L.N in the Left axilla measuring 1.8 cm. • Right: • Normal appreaing parenchyma. • Multiple small L.N in the Right axilla .

  13. CHEST X-RAY

  14. CT SCAN CHEST ,ABDOMEN &PELVIS

  15. Bone scan

  16. Histopathology True cut Biposy Invasive Ductal Carcinoma ER/PR Status : +ve HER 2 score : +1

  17. Diagnosis Invasive Ductal Carcinoma . Stage 3 Locally advanced Breast Cancer.

  18. mangement referred to the Oncology. Started on the AC Regimen ( Adriamicin, Cyclophosphamide) 4 cyles, once every 3 weeks . It will be followed by the taxanes for 4 cyles.

  19. mangement Down staging of the tumor for operation. MRM with axillary L.N dissection . Plastic surgery Referral for possible Pectoralis Muscle flap.

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