EXAMINATION OF SCC

1. SQUMOUS CELL
CARCINOMA OVER
RIGHT GLUTEAL
REGION
ATUL KUMAR
KHARE

2. Detail
 Name : SUKHIYA BAI
 Age / sex: 58y/F
 Residence: KATNI MP
 Occupation: FARMER
 Religion- Hindu

3. Chief complains
 c/o pain over right gluteal growth -4 months
 c/o bleeding from growth since – 3 months

4. HOPI
 Patient noticed swelling over right gluteal region since 2 years
back , 2 years back which not associated with pain, initially it
was pea size ,swelling gradually increasing in size .
 She had c/o pain over swelling since 4 months back when she
was injured by falling over ground over swelling. pain was non
colicky ,constant and dull aching in nature, insidious in onset
,mild to moderate in intensity, radiating over right lower
limb , aggravated by walking and relieved on taking
medications and rest.
 Swelling get ruptured and sero-hemorragic fluid comes out
,after that she developed rapidly increasing ulcerative growth
associated with pain and difficulty in standing from sitting
position and pain during walking

5.  c/o loss of weight (45 to 40kg ) last 6 months and loss
of appetite (4 chapati to 2 chapati per day).
 NOT ASSOCIATED WITH =
 n/o c/o mass coming out per rectum or pruritus.
 n/o c/o abdominal distension/ jaundice/fever.
 no c/o cough / hemoptysis.
 n/o c/o passage of mucus or blood in urine.
 n/o c/o tenesmus or incontinence.
 No h/o radiation in past.
 No h/o fever

6. Past history
She was p/h/o hypertension since 5 years and patient on
medication since then
No p/h/o tuberculosis/bronchial asthma /seizures
/diabetes mellitus/COPD/
No h/o any chronic medical or surgical illness
No h/o radiation in past

7. Personal history:
 Patient taking mixed diet
 Bladder function are normal.
 Difficult sleeping pattern due to pain ,for which he
takes medication.
 No history of addiction to alcohol or tobacco.
 Bladder and bowel habits are normal
 No allergy or any drug addiction

8. Family history
 No c/o similar complains in any family member or
relatives.

9. O/E
 The patient was examined with proper implied consent
in adequate light with female assistance.
 The patient is conscious /oriented to time / place and
person.
 The patient is average in built.
 Height -140cm weight - 40kg

10.  P- 80/min [ taken in right radial artery which is regular/
normo-volumic and there is radio radial or radio
femoral delay].
 BP- 150/90 mmHg taken in left brachial artery in supine
position.
 e/o pallor(+)
 No e/o icterus /cyanosis/clubbing /Edema

11. Per abdominal examination
 Inspection:
 The abdomen is exposed from xiphisternum to pubic
symphysis which is normal in contour, not distended ,
no e/o any lump present.
 All quadrants moves proportionately with respiration
.The umbilicus is central and inverted.
 No e/o any dilated veins /scars/or lymphadenopathy
present
 No cough impulse seen on Hernial orifices.
 No visible peristalsis seen

12. Palpation
 The findings of inspection are confirmed on palpation.
 On superficial palpation there in no increase in
temperature or tenderness.
 Abdomen is soft and no guarding /rigidity or any
palpable lump present.
 No inguinal or cervical lymphadenopathy present.
 There is no Organomegaly , no cough impulse present
over the hernial orifices.

13. Auscultation
 Auscultation- No Crepts
 BL air entry equally present
BS+
s1s2+, no murmer present
 Percussion:
Puddle sign negative .
Liver span is normal.
Tympanic note present over the abdomen.

14. Per rectal examination
 Per rectal examination is done in SIMS position after
taking consent and explaining the procedure.
on inspection=
No e/o any fistula / growth /sentinel pile /any infection
present in perianal area
on digital examination=
Normal anal tone present.
No overgrowth present
On proctoscopy=
No e/o any polyp or haemorrhoid and rest of the anal
canal and rectum is normal

15. Swelling examination
Inspection
 An 8*6*3 cm ulcerate-proliferative , cauliflower like
growth seen over right gluteal region at 3cm below from
PSIS, 2 cm supero-laterally from anal verge, 5cm superior
from hip joint and 2cm lateral to natal clefts and 8cm
above from gluteal fold .
 Skin around growth found thickened and Endurated .
 No dilated veins, any scar mark, hyperpigmentation present
 Shape-irregular cauliflower like
 Margin- everted
 Edges- everted
 Floor-sloughy

16. Picture

17. Palpation
 No local rise in temperature
 Tenderness present
 Size- around 10*8*4cm
 Shape- irregular
 Consistancy -firm to hard
 No any bony tenderness
 No any joint involvement

18. Fixity
 Skin Fixity – fixed with skin
 Muscle fixity - Fixed with gluteus maximus - sitting
to stand up test positive
 Bone fixity- not fixed

19. Lymph node Examination
 No inguinal lymph nodes enlargement found

20. Summary
 58 YEAR OLD LADY PRESENT WITH PAINFUL, RAPIDLY
PROGRESSIVE ULCERO-PROLIFERATIVE GROWTH SINCE 4
MONTHS OVER RIGHT GLUTEAL REGION WITH DIFFICULTY
IN STANDING FROM SITTING POSITION
 ON EXAMINATION THERE WAS A LARGE 10*8*4CM
ULCERO-PROLIFERATIVE GROWTH PRESENT WITH
IRREGILAR SHAPE AND EVERTED EDGES AND MARGINS
WITH HIGH VASCULARITY AND SURROUNDING SKIN HAVE
THICKENED AND ENDURATED

21. PROVISIONAL DIAGNOSIS
 SQUMOUS CELL CARCINOMA

22. MEDIAL LATERAL
SUPERIOR
INFERIOR

23. THANK
YOU