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 breastFirm

Hot

Tender

Left arm swelling

No 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.