Approach to a Patient With Breast Lump

Presented by:
Dr. ABUBAKAR RIZWAN
PGR GENERAL SURGERY
Biodata

 name: musarat
 Age: 56 years
 Gender: female
 Marrital status: married
 Address: Gujrat
 Occupation: housewife
 Mode of admission;OPD
Presenting complaint:

1. painless lump left breast for 1 year

2. ulceration over lump for 4 month
D/D

1.malignancy
2.Fat necrosis
3.Tuberculoma
4.giant fibroadenoma
Hx. Of presenting illness

 Patinet was alright 1 year ago when she noticed lump in her left breast just above the
nipple.
 Lump was gragually in onset ,noticed by patient herself,size of pea, gradually increased in
size ,initially arround 1 into 1 cm and now approximate size 6 into 5cm never
disappeared, doesn’t associate with pain or any discharge from nipple and there is no Hx
such lump present elsewhere in body
 She also noticed ulcer over the lump about 4 month ago and it cause more attention when
it bleed about 3 month ago,gradually increases in size and no Hx such ulcer present
elsewhere in body
 There is no other swelling in both axilla ,rt breast or body.
 No history of
 truama ,bruising
 fever ,night sweats ,weight loss
 Nipple discharge
 Jaundice,dyspnea,cough,backache,neurological symptoms
 There is no hx. Of such breast lump in family
Systemic hx.

 No significant systemic hx.

Past hx.

.No hx of TB
.No OCP or HRT
.No Chronic medical illness
.Appendectomy done 40 year ago
.Chemotherapy and radiotherapy
.Past gynaecological /obs hx:
menarrche at the age of 11 year with regular cycles 3-4 days duration
menopause at the age of 44
5 abortions
5 children alive(all SVDs)
breast feeding for last 3 children about 6-8 month for each
Family hx.

No family hx of cancer in first degree relative

No hx of BRCA related malignancies in family like pancratic,prostate,colorectal and ovarion
Personal and socioeconomic hx.

 Non smoker ,non addict

 Normal sleep and appetite
 Normal bowel/bladder habits
General physical examination

 A female lying comfortably on bed

 Conscious,alert,cooperative and well oriented to time,place,person.
 B.p : 130/80 in left arm,supine position
 pulse: 74/min ,regular,normal volume
 R.R :12/min,regular
 temp: A/F
 No pallor/cyanosis/jaundice/clubbing
 Left supraclavicular LN palpable
 Examination of cardiovascular,respiratory and abdomen system normal.
 Lumber spine examination normal
Local examination

 Inspection:
 Arm at side,elevated,hands on hips pressing and relax,bending forward position
 RT brest and axilla are normal
 nipple of left breast inverted with no discharge.
 6 into5cm lump at LT upper and inner quadrant of breast,no skin
nodules,pigmentation,vascularity
 Irregular Skin ulceration of about 2into3 cm over the upper inner quadrant of left breast
having everted edges,non granulating floor with no smell
 Palpation: the temperature is comparable to surrounding skin and both breast are nontender
 There is 6*5cm lump in upper outer and inner quaderent of LT breast,
 non mobile,hard ,non tender,ill defined margins.
 Fixed to chest wall.
 LT supraclavicular lymph node were palpable with firm consistency and non mobile
 NO axillary LN palpable
 Examination of abdomen normal
 Examination of thoracic spine normal
 PV AND DRE intended
 SUMMARY

58 year postmenopausal women with painless lump in left breast since 1 year.gradually
increases in size with nipple retraction and ulceration for 4 months with no
nippledischarge.no history of tuberculosis,trauma,first degree relative carcinoma,distant
metastasis.no history of menstral irregularities,OCP and 5 abortions.
 On examination nipple of left breast inverted with no discharge.6 into5cm lump at LT
upper and inner quadrant of breast,no skin nodules,pigmentation,vascularity.Irregular
Skin ulceration of about 2into3 cm over the upper inner quadrant of left breast having
everted edges,non granulating floor. LT supraclavicular lymph node were palpable with
firm consistency and non mobile.NO axillary LN palpable
Provisional diagnosis

A 56 year postmenopausal lady normotensive and normoglycemic having carcinoma of LT

breast clinical stage T4N3M1
Investigations

 1. Basic : all Baseline

 2.DIAGNOSTIC :
 USG/mamograpy
 FNAC/true cut biopsy
 3. Satging investigations
CT abdomen, chest ,pelvis
 Alkaline phosphatase
treatment

 Locoregional
 MRM and sample send for H/P
 Histopathology for
 1.conformation of diagnosis
 2.Type of tumor
 3.Grade of tumor( pleomorphism)
 4.lymphovascualr status invasion
 5. ER/PR status and HER2neu2 status
 6. resected margins status
 radiation
Systemic control

 Chemotherapy
 Harmonal therapy
Follow up

 After 3 month for 1 year

 6 month for 2 year
 Yearly for 5 year.