Useful for Surgery Residents for presentation.

1. LONG CASE
by Dr Sumit SCB

2. CHIEF COMPLAINTS
• My patient Ms Swarnalata Swain, 52yrs, HF, from Kendrapada,
presented to Surgery OPD with c/o of lump in the upper outer
quadrant of right breast since 2 months.

3. HISTORY OF PRESENT ILLNESS

4. PAST HISTORY
• No such h/o of similar lump in either breast in the past
• No h/o – T2DM , TB, HTN
• No past h/o radiation to chest

5. PERSONAL HISTORY
• Farmer by occupation
• Taking avg mixed Indian diet
• Bowel and bladder habits are normal
• Not addicted to any substance

6. FAMILY HISTORY
• No h/o breast cancer in first degree relatives
• No h/o BRCA related malignancies in family

7. MENSTRUAL HISTORY
• Attained menarche at 13 yr with regular cycles of normal
flow, volume and duration.
• Attained menopause at 45 years.

8. OBSTETRICS HISTORY
•Married at 26yr, blessed with 2 sons all by NVD, both were
full term.
•No h/o abortion
•1st child birth at 27 yrs age, last child at 31 yrs.
•All children were exclusively breastfed.

9. TREATMENT AND DRUG HISTORY
• Not undergone any surgical intervention before except
family planning.
•No h/o of intake OCP or HRT.

10. GENERAL EXAMINATION
• Informed consent
• Well lit room
• Adequate privacy
• In front of a female attendant
• Pt was conscious, co-operative and well oriented to time,
place and person
• Performance score of 90 on Karnofsky scale

11. GENERAL EXAMINATION
• PR- 70 bpm, regular rhythm, normal volume, no radio-radial
and radio-femoral delay
• BP-120/78 mm hg at right arm supine position
• RR-16 /min abdomino-thoracic
• No e/o pallor, icterus, cyanosis, clubbing, pedal edema and
generalized lymphadenopathy

12. INSPECTION
Patient in sitting position with arm at
side
• Both breasts appear normal shape,
symmetry , position and right breast
slightly larger than the left
• Nipple areola complex of right breast
slightly lower than the left breast in
horizontal plane
• visible lump over the right breast
• No scar mark, no engorged veins
• Skin over both breasts normal

13. PATIENT RAISING HER BOTH
ARMS –
• nipple areola complex of both breast
at same horizontal line
• Visible fullness over upper outer
quadrant of right breast
• No visible skin changes
• No nipple retraction

14. • PATIENT LEANING FORWARD-
• Right breast fall more on leaning forward

15. Axilla, Supraclavicular Fossa and
Upper limbs appears to be
normal.

16. PALPATION
LEFT BREAST – no local rise of temperature, no lump palpated in breast
as well as in the axilla
RIGHT BREAST– no local rise of temp or tenderness noted
• A Lump of size 3*3 cm palpated in UOQ
• Hard in consistency
• Irregular, ill-defined margin
• Uneven surface
• Lump is fixed to breast tissue
• Not fixed to overlying skin
• Not fixed to underlying Pectoralis Major muscle and chest wall
• Nipple areola complex normal , no discharge from nipple on pressing
the lump.

18. Examination of Right Axilla
• Single, mobile, non-tender lymph node of size 1.5× 1.5 cm
• Firm in consistency in anterior group of nodes
• No palpable lymph nodes in Left Axilla
• No palpable lymph nodes in Rt. and Lt. Supraclavicular fossa

19. SYSTEMIC EXAMINATION
Respiratory examination-
• trachea centrally placed
• B/L air entry present
• normal VBS
Cardiovascular examination –
• s1 s2 N M0 NAS
Abdominal Examination
• Abdomen normal in shape, umbilicus centrally placed ,skin over
abdomen normal.
• No organomegaly and no free fluid in abdomen.
Musculoskeletal Examination
• No bony tenderness or any skeletal deformity
PV and DRE
• No growth or mass palpated

20. SUMMARY
A case of 55yrs post menopausal lady with painless, progressive lump in
upper outer quadrant of right breast since 2 months without any
ulceration, nipple discharge and without any h/s/o distant metastasis.
•O/E a non-tender lump of 3*3 cm palpable in UOQ of the right breast
with ill-defined irregular margin, uneven surface, hard in consistency, fixed
to breast tissue and not fixed to overlying skin or underlying Pectoralis
Major muscle and chest wall. A Single, mobile, ipsilateral 1.5 × 1.5 cm level
1 pectoral lymph node palpable with other systemic examinations within
normal limit.
• MY PROVISIONAL DIAGNOSIS – CARCINOMA OF RIGHT BREAST HAVING
TNM STAGING T2N1M0 (STAGE IIB).