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Case of Breast Carcinoma

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History

45 yrs/lady

Resident of Bihar

Illiterate Low socio-

economic status

House maker

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HistoryChief complaints

-Lump in right breast x 6 months

-ulceration in the swelling x2 months

Insidious onset, initially 2 x 2 cms , rapidlyprogressed to present size of 10x10 cms

Initially painless but since 2 months patientcomplains of dull aching continuous pain whichgets relieved by medication

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History

H/o ulceration 2months back,

associated with foul

smelling discharge

Ulcer progressively

increased in size to

present size of 7x7 cms

No h/o discharge fromthe nipple

No h/o retraction of

nipple

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History

No h/o loss of weight /appetite

No history suggestive of metastasis like

hemoptysis, breathlessness, bone pains,

jaundice, headaches, sezuires

No h/o bowel or bladder disturbances

No h/o of intake of oral contraceptive pills No h/o any addictions

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History

Menstrual History

Attained menopause 5yrs back

Menarche at 12 years

P3L3, Breast fed all children

First child birth 20 years back

Family history

No h/o of breast cancers, ovarian or colorectal

malignancies in family (first degree relatives).

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Examination

Middle aged, postmenopausal female

Moderately built and nourished

Conscious ,co-operative,well oriented totime, space and person

Patient occupying decubitus of choice

Performance status = 90 (Karnofskys) Normal hydration

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Examination

Vitals

Pulse84/min, right radial, regular

BP124/80 mm Hg

Respiratory rate17/min

Afebrile to touch

No pallor/icterus/edema/cyanosis

No generalised lymphadenopathy

Right axillary lymphnode - palpable

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Examination

Left Breast and axillaNAD

Right breast-

-Nipple-areola complex slightly at higher level than left,seen

more prominently when patient lifts both her arms up

- prominent veins present over chest wall and breast Ulcero-proliferative growth in the upper outer quadrant,

10 x 10 cms

Irregular margins, Everted edges and slough on the floor

with pale granulation tissue Foul serosanguinous discharge

Bleeds on touch

Indurated surrounding skin.

Nipple not retracted/no discharge

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Examination

Firm, mobile {not fixed to pectoralis

major muscle}

Irregular margins No other lump palpable in the right

breast

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Examination of Breast

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Examination of Breast

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Examination

Axilla Enlarged central

group of lymphnodes

3 in number

Maximum size of

2x2cms

Mobile

B/L Supraclavicularregions are not full

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Examination

Respiratory systemnormal

Cardio-vascular systemS1S2 heard, no

murmurs

Central Nervous systemnormal

Per abdominal examinationnormal

Spine and external genitalianormal P/R &P/V examination- NAD

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Diagnosis

45 years, post menopausal lady with

fungating growth in the right breast s/o

locally advanced breast carcinoma -

T4bN1M0