This document presents a case report of a 40-year-old woman who presented with a rapidly enlarging swelling in her right breast over the past 4 months, which had reached approximately 10cm in size. She also reported a smaller swelling in her right axilla for the past 2 months. More recently, she developed an ulcer on her right breast above the swelling associated with serous discharge and pain. On examination, asymmetry was noted between breasts with the right breast higher than the left. An ulcer was seen on the right breast involving the nipple with serous discharge. Differential diagnoses included phylloides sarcoma, plasma cell mastitis, tuberculosis of the breast, and chronic fat necrosis.

1. CASE PRESENTATION-
IRREGULAR BREAST LUMP
• DR.HASSAN ZAMIR AHMED
• 1ST YEAR PGT

2. HISTORY
• Mrs.XYZ ,40 Year old,Hindu lady ,Resident of
Budge Budge,Home maker
• Chief Complaints-
• Swelling in right breast x 4months
• Ulceration and pain over swelling in right breast
x 2weeks

3. HISTORY OF PRESENTING ILLNESS
• She noticed the swelling of approx 2cm in right
breast 4 months back
• Rapidly progressed to current size of approx 10cm
• Not associated with pain or fever
• 2months later another swelling appeared in right
axilla of about 1-2cm in size
• Gradually increasing in size
• No other swelling in opposite breast or axilla.

4. Cont.
• She developed an ulcer in the nipple areolar
complex 2 weeks back just above the swelling
• Ulcer was associated with serous discharge
• It was also associated with pain
• Pain was localised to regions of ulcer,sudden
in onset,dull aching in character,relieved on
taking medication,no aggravating factors

5. cont.
• No h/o nipple discharge
• No h/o trauma/radiation exposure in the past
• No h/o chest pain, cough
• No h/o loss of weight or appetite
• No h/o pain in abdomen or jaundice
• No h/o lower back ache ,pain in limbs
• No h/o headache/vomiting or weakness of any
limbs
• No history of Diabetes, hypertension/
hypothyroidism

6. PAST HISTORY
• No h/o similar complaints in the past
• No past h/o tuberculosis
• No past h/o surgical intervention

7. FAMILY HISTORY
• No h/o breast, ovarian, prostate or GI
malignancies in 1st degree relatives or family
members.

8. MENSTRUAL AND OBSTETRIC HISTORY
*Menarche at the age of 12 years
*Married at age of 16 years
*1st child at age of 23 years Youngest child of age
5 years
* 4 children
*All breastfed for minimum 2 years
*No h/o intake of any birth control pills
*Has normal menstrual cycles

9. PERSONAL HISTORY
*Diet-Vegetarian
*Normal sleep pattern
*Normal bowel and bladder habits
*Non smoker/non alcoholic
*No known allergies

10. To summarize….
• 40 year premenopausal lady presented with
rapidly progressing swelling in her right breast
for 4 months which is at present of approx. 10
cm and a ulcer over the swelling for the last 2
weeks associated with serous discharge.
• She complained of another swelling in her
right axilla for last 2 months
• Negative metastatic and family history.

11. General Physical Examination
*Conscious,oriented to time, place and person
*Built-average
*Performance status-90(Karnofsky scale)
*Well hydrated
*BMI-24.1kg/m2
*No pallor,icterus,clubbing,cyanosis,pedal edema
*Generalised lymphadenopathy –
*Regional Lymphadenopathy +
Vitals-
*BP-120/80 mm of mercury,PR-80bpm,RR-24/mint,
temp-afebrile

12. LOCAL EXAMINATION
• Inspection-Asymmetry noted with
right breast lying at a higher level
• Visible fullness in right upper outer quadrant
• Shiny, engorged veins, peau d’ orange present
• An ulcer present over the swelling of size
1X1cm in UOQ involving nipple areoler
complex,irregular in shape,everted edges and
floor with pale necrotic tissue
• serous discharge present

13. • On leaning forward the left breast fell more
forward
• B/L NAC - no nipple discharge.
• Right NAC was approx. 3cm higher then left
,distorted & nipple retracted.
• Right nipple involved in the ulcer.

14. • On raising both the arms above head-right
nipple retracted and peau d’orange becomes
more prominent
• Axilla,arm and thorax appears normal

21. Differetial diagnosis
• Phylloides sarcoma
• Plasma cell mastitis
• Tuberculosis breast
• Antibioma
• Chronic fat necrosis

22. Thank you