Tuesday, June 26, 2012

Surgery : Breast Carcinoma

Today, we had a great class of breast carcinoma. It is a very important class. Dr M taught us on the do's and the dont's of breast carcinoma examination.Yeah, and he did that in between the time when patient comes in and out of the OPD. Sometimes, after listening to Medical Representatives suggesting their companies drugs to be used in OPD.After 3 postings of surgery in India, i am now adapting well to norms of system.Well,  Dr M asked us  to present the case and yada yadda we told him about patient's history,inspection and palpation of breast while he expressionlessly  nit-picking using flat toned manner with tons of viva-style questions.

Picture courtesy from Radiology Malaysia.org

Now, here we go and present the case.

Chief complaint :She complains of painful left breast  since 1 month ago.

Long case made short.

Among positive findings that we encountered are :

On inspection there is presence of single ulcer at  the left breast with multiple nodules. The breast of affected site sags and the skin of breast seems normal. The nipple of the left breast is destroyed and floor of ulcer is covered by slough and seropurulent discharge.

By palpation we could feel the hardness of the breast lump which is multiple in number,varied in size between 5mm to 1.5cm. The breast ulcer is tender  and bleeds on touch, fixed to the breast tissue and have sloping edge with indurated margin. Single solitary axillary lymph node is appreciated.

Diagnosis :

 T4b Tumour with involvement of the skin in the form of eodema,ulceration and satellite skin nodules.

N1 Mobile ipsilateral axillary lymph node.

Note: Wear gloves  and wash your hands in between patients dear doctors!

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