CASE PRESENTATION OF BREAST CARCINOMA

CASE HISTORY NAME- Aarti AGE- 50 yrs SEX- Female ADDRESS- Mahendergarh RELIGION- Hindu MARITAL STATUS- Married OCCUPATION- Housewife CHIEF COMPLAINTS- Lump in rt breast for 3 months

HISTORY OF PRESENT ILLNESS Pt. was apparently asymptomatic 3 mnts back when she first noticed a lump in rt breast LUMP- Upper outer quadrant Insidious in onset Gradually progressive (initially of size of lemon and increased to the size of orange) Ass. with bloody discharge Recent retraction of nipples Not ass. with pain,itching and vesicle formation 7. No aggravating and relieving factors 8. H/O wt. loss , decreased apetite 9. No H/O fever 10. No H/O bone pain , difficulty in breathing, chr. cough, chest pain, abd. Pain 11. No H/O radiation exposure. 12. No H/O other lump in same or other breast

PAST HISTORY No H/O similar complaints in the past on the same side or on other side No H/O trauma, previous surgery No H/O TB, DM, Epilepsy, HTN

PERSONAL HISTORY Non smoker Non alcoholic Non vegetarian MENSTRUAL HISTORY- Menopause 3 yrs back

FAMILY HISTORY No H/O similar complaint in the family- specially in mother or first generation relative No H/O ovarian or endometrial CA in mother or sibling

GENERAL PHYSICAL EXAMINATION Pt. is conscious, cooperative, well oriented to time, place and person and lying comfortably in the bed Pt. has – Pulse= 96/ min RR= 18/min BP= 120/90 mm Hg Temp. = 98.8*F On GPE- No pallor No icterus No cyanosis No pedal odema No clubbing Lymphadenopathy +nt

LOCAL EXAMINATION Pt. is examined in sitting position in well illuminated room On Inspection- RT BREAST- Rt breast distorted in shape and comparatively larger than lt Orange peel appearance No ulceration, fungation, scar mark No dilated veins Visible lump seen in rt breast in upper outer quadrant at 10’o clock position LT BREAST- No visible lump seen NIPPLE- Not symmetrical Rt nipple placed higher than lt Retraction of rt nipple seen Bloody discharge seen

AREOLA- No cracks, fissures, swellings seen ARM- No odema seen On Palpation- LT BREAST- No mass palpable RT BREAST- Temp –Normal No tenderness LUMP- +nt in upper outer quadrant at 10’o clock position, reaching to upper inner quadrant and +nt upto nipple Size- 10*8 cms Hard consistency Uneven surface Regular margins Fluctuation test –ve On trans illumination test appears opaque Fixity to breast tissue, skin Adherent to nipple Bloody discharge from nipple

LYMPH NODE EXAMINATION Carried out in sitting position Pectoral gp of lymph nodes- are enlarged single in no. located along antr axillary fold hard consistency matted mobile no skin changes no scar mark no odema of arm No other gp of lymph nodes are palpated

PROBABLE DIAGNOSIS BREAST CARCINOMA DIFFERENTIAL DIAGNOSIS- Giant Fibroadenoma Breast cyst Paget’s disease

DISCUSSION A 50 yrs old female , married, with two children came in the OPD with a chief complaint of lump in rt breast for 3 mnts which was insidious in onset, progressively increasing in size with no pain and H/O significant wt. loss and bloody discharge, no +ve family history, on examination a solitary lump of size 10*8cm is +nt in upper outer quadrant, reaching to upper inner quadrant +nt upto nipple having hard consistency, irregular margins, uneven surface, fixating to breast muscle and pectoral muscles with axillary lymph node enlargement. The probable diagnosis is breast carcinoma

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