AMAI PAKPAK MEDICAL CENTER

DEPARTMENT OF SURGERY

TUMOR BOARD CASE PROTOCOL

Prepared by:
Shereen S. Lucman

OBJECTIVE

 Present a case of M.O, 56 yrs. old female with Mucinous Carcinoma of the
breast, right; S/P Modified Radical Mastectomy, Right; Drain (7/14/21,
APMC); S/P Excision Biopsy (6/25/21, APMC)

 To have a multi-disciplinary discussion on the ideal approach of this type of

breast cancer

MEDICAL HISTORY

IDENTIFYING DATA

• This is a case of M.L, 51 yrs. old, female, Filipino, Islam from

Ambolong, Marawi City who was admitted last July 5, 2021.

SOURCE AND RELIABILITY

Patient, 90%

CHIEF COMPLAINT

Breast mass, right

HISTORY OF PRESENT ILLNESS

3 months PTA, the patient noted 2x2 cm non-moveable, non-tender, non-

erythematous mass on the peri-areolar area. No consult done. Condition tolerated.
In the interim, noted gradually increasing size of mass.
1 week PTA, patient decided to sought consult and Mammography of the breast
was requested, result revealed Solid mass at the right breast. BI-RADS Category 3.
Probably benign. Patient was then advised for Biopsy. Excision biopsy was done
revealing Mucinous Carcinoma. Patient was advised for surgery hence this
admission.

PAST MEDICAL HISTORY

Patient has no history of previous hospitalization nor underwent any surgical

procedure.
Patient has no known co-morbidities.
Patient has no known allergies to any foods or medications.
FAMILY HISTORY

There is no known family history of bronchial asthma, hypertension, diabetes

mellitus, or any other malignancies.

PERSONAL AND SOCIAL HISTORY

Patient is single and a teacher.

Patient is non-smoker and non-alcoholic beverage drinker and denies illicit drug
use.
Usual diet consist of rice, fish and vegetables

PHYSICAL EXAMINATION

General Survey : awake, conscious, coherent, not in respiratory distress

Vital signs : BP 120/80 mmHg, HR 90 bpm, RR 20 cpm, T 36.4°C,
Anthropometric measurement:
Weigh 61 kg Height 143 cm BMI 29.83 kg/m2 (Overweight)
Performance Status: Karnofski score: 100
: ECOG score:0

Skin No rashes or lesions, No discolorations

Warm to touch
Good skin turgor

HEENT Head: normocephalic, normal hair distribution, no facies

Eyes: anicteric sclerae, pale palpebral conjunctivae
pupils equally reactive to light
Ears: no discharge
Nose: no flaring of the ala nasi, no discharges
Mouth: moist oral mucosa, no tonsillopharyngitis

Neck Supple, no nuchal rigidity

Trachea at midline, no lymphadenopathy, no mass

Chest and Symmetrical, equal chest expansion

lungs Equal tactile fremitus
(+) occasional rales, bilateral

Breast Right: 4 cm incision site on the peri-areolar area

Left: Unremarkable

Heart PMI at 5th intercostal space left midclavicular line

No heaves, no thrills
Regular cardiac rhythm, no murmurs, no adventitious sounds

Abdomen Flabby, no scars, no skin discoloration

Normoactive bowel sounds
Soft, non-tender abdomen
Back No deformities
No CVA tenderness

Extremities Strong and equal pulses, CRT <2s, (-) edema

Genitalia Not elicited

Rectal Exam No external hemorrhoids

Good sphincter tone
Smooth rectal mucosa, (-) Mass

Neurologic GCS 15

PRIMARY IMPRESSION
Mucinous Carcinoma, right breast, Stage IIA (cT2N0M0)
S/P Excision Biopsy (6/25/2021, MCH)

DIAGNOSTICS

CBC with differentials:

7/05/21 7/13/21 7/15/21 Normal Values
WBC 8.52 8.70 12.4 5.0-10.0x109/L
Neutrophils 51 44 68 50-70%
Lymphocytes 41 46 27 20-40%
Monocytes 7 9 5 0-5%
Eosinophils 0.01
Basophils
RBC 4.11 3.98 3.49 4.0-5.5x1012/L
Hemoglobin 11.50 11.30 10.1 14.0-18.0g/L
Hematocrit 0.36 0.35 0.31 0.35-0.45
Platelet 360 280 229 140-340x109/L

URINALYSIS

7/13/21 Normal
Values
Color Yellow Yellow
Transparency Clear Clear
Reaction (pH) 6.0 5.5-6.5
Sp. Gravity 1.015 1.010-1.030
Sugar Negative Negative
Protein Negative Negative
RBC 19 0-2/hpf
Pus cells 3 0-5/hpf
Epithelial Cells 7 Few
Bacteria 262 Few
COAGULATION
7/05/2021 ER

PROTHROMBIN TIME
PATIENT CONTROL Normal Values
RESULT 11.2 12.1 10 – 14
seconds
% ACTIVITY 105.9 93.3 >70%
INR 0.95 1.03 <1.16
APTT
RESULT 34.9 33.1 24 – 39

ROUTINE CHEMISTRY

7/05/21 7/13/21 7/15/21 Normal Values

FBS 261 70-105 mg/dl

HbA1c 6.4 <6.5
BUN 18 7.94-20.1 mg/dl
Creatinine 0.7 0.7 0.5 0.40-1.40 mg/dl
Cholesterol 294 <200
SGPT 113 up to 32 U/L
SGOT 120 up to 31 U/L
LDH 245 225-450
Sodium 146.60 140.4 138.5 135-155 mmol/dL

Potassium 4.51 4.46 4.34 3.5-5.3 mmol/dL

Creatinine 0.70 0.50 0.40-1.40 mg/dl

IMMUNOLOGY -SEROLOGY

HbsAg- Nonreactive
CARDIAC 7/13/21 Normal Values
MARKER
D-Dimer 0.62 mg/L 0-1.35 mg/dl

7/05/21 Normal Values

ER
Free T4 13.55 pmol/L 9.0- 19.0 mg/dl
TSH 1.29 Uiu/mL 0.35- 4.94 mg/dl

Chest Xray: Bilateral Pneumonia

Bilateral Digital Xray Mammography (06/15/2021, AMC)
Breast composition: Category C. The breasts are heterogeneously dense, which
may obscure small masses.
There is a partially circumscribed equal density non-calcified mass seen at the upper
outer quadrant of the right breast approximately 2 cm from the 1.7 cm from the
nipple.

Sonographic Correlation: Concordant with Xray Mammography is a solid lobulated

mass at the right breast, 10-11 o’clock location, periareolar areas. The mass
measures 2.82 x 2.14 x 2.85 cm. Posterior shadowing was noted at the periphery.
No other masses seen in both breasts. Both axilla showed no enlarged lymph nodes

Assessment: Solid mass at the right breast. BI-RADS Category 3.

Probably benign

Excision Biopsy (1/20/21, APMC)

Mucinous Carcinoma
Tumor size: 3.8 cm
No lymphovascular invasion observed
Medial/Anterior margin, positive for tumor

PRE-OPERATIVE DIAGNOSIS
Mucinous Carcinoma, right breast, Stage IIA (cT2N0M0)
S/P Excision Biopsy (6/25/2021, MCH)

CONTEMPLATED PROCEDURE

Modified Radical Mastectomy, Right;

OPERATION PERFORMED

Modified Radical Mastectomy, Right; Drain

SURGICAL PATHOLOGIC REPORT

Breast, Right, Modified Radical Mastectomy
Negative for residual malignancy
Nipple negative for tumor
Surgical margins, negative for tumor
16 axillary lymph nodes, negative for metastasis

FINAL DIAGNOSIS

Mucinous Carcinoma, breast, right Stage IIA (cT2N0M0)

S/P Modified Radical Mastectomy, Right; Drain (1/26/21, APMC)
S/P Excision Biopsy (1/20/21, APMC)

POST-OPERATIVE PLAN
Adjuvant Chemotherapy