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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 - PowerPoint PPT Presentation
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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• Bloody nipple discharge • Skin changes• Fungating Ulcer
History
• No Family history of breast cancer• No history of benign breast disease or
biopsy
• No history of smoking.
History
• Age of menarche: 14 • Age of menopause : 50 • She had her 1st child birth at 30 years of
age• No History of OCP
• Systemic Review unremarkable • Past Surgical History Lateral anal sphincterotomy 2 years back• Allergies -ve• Medication
– Thyroxin – Mobic – Capotin
Physical Examination
Vital signs
CVS UnremarkableChest Abdomen
Breast Examination
• Right breastNormal with free axilla
• Left breastEnlarged Red EdematousFungated ulcerBloody discharge
• Left breastFirmHotTenderLeft arm swellingNo axillary LN
Investigation
Blood work:• CBC• U&E NORMAL
• LFT• Serum Calcium
Investigation
Radiological • Mammogram
– Left breast : was not done .– Right breast : Benign prominent ducts.
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 .
CHEST X-RAY
CT SCAN
CHEST ,ABDOMEN &PELVIS
Bone scan
Histopathology
True cut Biposy Invasive Ductal Carcinoma
ER/PR Status : +ve
HER 2 score : +1
Diagnosis
Invasive Ductal Carcinoma .
Stage 3 Locally advanced Breast Cancer.
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.
mangement
Down staging of the tumor for operation.
MRM with axillary L.N dissection .
Plastic surgery Referral for possible Pectoralis Muscle flap.