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Name:Madam Mary Asante Age: 68yr Sex:Female Occupation: Farmer Religion:Christian[Catholic Marrital status:Married !ith "children Residence: Se#!

i $ia!so PC %Rt &reast mass%'yr HPC (atient !as !ell until ' yrs ago !hen she noticed !hile dressing a mass in her right &reast) *he s!elling is not associated !ith pain nor nipple discharge) *he mass has &een increasing progressi+ely in si,e and since) She has associated !eight loss and anorexia) She reported to Se#!i $ia!so hospital !here she !as examined and as-ed to report to .A*/ #or expert management) ODQ Fe+er%+e Mass is painless S-in changes o# in+ol+ed &reast%+e $eight loss0 Anorexia0 Cough%+e 1reathlessness%+e Chest pain%+e (alpitations0 2i,,iness0 $aist pains%+e 3aundice%+e Re+ie! o# other systems yielded no signi#icant #indings PM&SH (re+ious hx o# &reast dx%+e /x o# chronic medical illness 2M4*1 /*N 5pilepsy 4Asthma4SC2) (re+ious hospital admissions%+e Surgical Operation%+e /aemotrans#usion%+e REPRODUCTIVE Hx Menarche !as at '6yr She has no hx o# contrcepti+e use)She had her 'st child !hen she !as 7'yrs and &reast #ed #or 6months and the last one at 68yrs)Menopause !as at 9'yrs DRUG Hx Not on any long term medications) No -no!n drug allergies) No hx o# her&al preparation use) FAMILY Hx *here is no #amily hx o# &reast ca4 o+arian ca or endometrial cancer) No -no!n #amily hx o# Chronic medical illnesses li-e 2M /*N SC2 5pilepsy4Asthma nor *1 SOCIAL HX She is a #armer and li+es !ith #amily at Se#!i $ia!so)She doesn:t drin- alcohol nor smo-e cigarettes)

SUMMARY ; present a 68yr old #armer !ho presented !ith a 'yr history o# a painless lump in Rt &reast !hich has &een progressi+ely increasing in si,e !ith associated !eight loss4 anorexia palpitations and di,,iness) IMPRESSION 1reast ca DD *raumatic #at necrosis Chronic &reast a&cess *1 o# R* &reast 1reast lymphoma Fi&roadenoma 2uct ectasia O/E 5lderly !oman !ho is ill loo-ing4 !aisted4 a#e&rile4 !ell hydrated4 anicteric and pale) CVS (ulse '<7&pm%regular4!ea- +olume non%collapsing) 1(%''<=6<mm o# /g) S'0S70< RS RR%'6cpm%regular Air entry ade>uate &ilaterally4 &reath sounds +ersicular !ith no added &reath sounds) Chest *he &reast !ere asymmetrical in si,e !ith an o&+ious &ulge in the right &reast4 there !as puc-ering R* &reast !ith nipple retraction) *here !as a mass palpated in the rt upper outer >uadrant o# the &reast4 measuring 9cm?7cm4 !as o+oid in shape4 had a rough sur#ace) ;t !as non tender4 edges !ere ill de#ined4 consistency !as hard4 attached to chest !all) *he s-in o+er it adherent to it) *here !as no di##erencial !armth nor nipple discharge) *here !ere palpa&le mo+a&le solitary axillary lymph nodes o# the R* axillary4 &ut no supracla+icular nor in#racla+icular lymphadenopathy) Abd !e" A&domen so#t non%tender4 no gaurding) @i+er4 -idneys and spleen not palpa&le) Shi#ting dullness negati+e) 1o!el sounds present and normal) /ernial ori#ices clear and no inguinal lymphadenopathy) MSS *enderness o+er spine%+e Ai&&us%+e (el+ic compression tenderness%+e CNS Concious and alert4!ell oriented in person place and time) *one po!er re#lexes appear intact) *here appears to &e no cranial ner+e a&normality) DIAGNOSIS 1reast ca DD #Chronic &reast a&scess %1reast lymphoma

INVESTIGATIONS D$%&" st$' %Mammogram o# &reast %*rucut &iopsy S()) *t$+e#Chest x%ray %A&domenal BSA %@i+er #xn test %1BN Createnine and electrolytes %1one scintigraphy %F1C %Brinalysis %Sic-ling TREATMENT 2ependent on the stage o# the disease[*NM C Manchester *his patient is T,b-N.-Mx Tx/ T t%0 !%ste't !1 2$th %x$00%*1 01!)h " de '0e%*%"'e3 i# the nodes are positi+e and the tumor is 5R% cyclical chemotherapyDCMF);# it is 5R04then tamoxi#en is ta-en #or 9yrs) ;n de+eloping countries4 oophorectomy is recommended #or premenopausal patients)i# 5R status is not -no!n4 chemotherapy is gi+en to premenopausal patients and tamoxi#en #or menopausal ones I!!ed$%te#post op haemorrhage %haematoma #ormation %pneumothorax E%*01#surgical site in#ection %seroma #ormation %shoulder sti##ness L%te#recurrence %!inged scapula %hypertrophic scar %-eloids Complications