First case :

54 year old female patient named Nefisa Ali Sedka from menyt elnasr ,
A housewife,widow with has no children, with no special habits. i met
the patient on OCMU on the 8th floor and she was cooperative and
oriented. i take a consent from her and started taking history by asking
her about her personal history and then her complaint she said that her
condition started 2 years ago by numbing breast pain she but ignored it
as she thought that this pain was related to menstruation as she heard
from people around her till 2 months ago she was sleeping and found a
mass in the outer quadrant of her breast then she decided to go to
baheya. she went but she waited for one month then she was diagnosed
by right breast cancer but her treatment was not available in baheya so
she was referred to mansoura university oncology center. she entered on
8/2/2024 and did alot of investigations as she said and by general
examination her skin is healthy with no ulcers but there was hair loss
from chemotherapy and she was a little bit tired,there were no symptoms
of other systems affection. on local examination of her breasts there’s no
discharge no ulcer no scars no fistula, I examined her both breasts
starting from the normal one then the diseased i palpated the mass which
was painless in the upper outer quadrant. she started neoadjuvant
chemotherapy 8 cycles last one was on 8/1 she said that the complication
of chemotherapy which were edema ,alopecia ,pururitis and color of the
nipple became darker after chemo also it became smaller. she is planning
to do conservative breast surgery tomorrow.
doctors suggested to her total mastectomy or to save part of her breast
and she chose to save her breast and do a conservative breast surgery. as
regard her drug history she took analgesics and treatment for pruritis and
hypersensitivity because of chemotherapy.
according to her medical history there’s no history of diabetes nor
hypertension but only for rehamtoid heart disease which is mild MR
and TR,her family history free. there’s no history of traveling,blood
transfusion nor surgeries done. i went to check her investigations on the
system
her cbc is normal and she is HBV, HCV and HIV negative, blood
grouping A and RH negative,PTT 12 (normal) ,LFTS and KFTS were
normal so it was safe for chemotherapy,her blood glucose is normal.
she has done a true cut breast biopsy and she is diagnosed with grade 2
infiltrating ductal carcinoma with focal lobular component. She is
positive ki-67 .
she did a breast mammogram the day she entered and it showed : density
B , right shows parenchymatous distortion of central region. normal left
breast BIRADS 2 and in the right one there was a suspicious mass with
with sus LN BIRADs 4c.
by Us : irregular shape w hypoechoic speculated mass 23x16 mm and
4.5mm from skin . two oval hypoechocic axillary ln with diffuse cortical
thickening and left breast normal and there was no suspicious LNs. and
she also did a metastatic workup by us abdomen and pelvis : liver w
spleen normal and there was no ascitis. her echo normal but there is mild
TR w MR .
patient is referred for conservative surgery next 2 days and unfortunately
i couldn’t attend the operation and i went to the hospital next week and
she was discharged.
No information about follow up in OCMU with the patient after surgery
second case :
A 70 year old female patient named Nemaat Mostafa from
Elmahalla,she is a widow with 2 offspring the youngest is 34 years old
with no special habits.
patient was not staying in the hospital and she came just before her
surgery so we couldn’t take the history and do the examination before
that.
We asked for a consent from her and her daughter to ask her some
questions and we took a personal history and asked her about her
complaint and she said that she first presented with right breast mass 1
year ago suddenly. Patient was cooperative but she was old and didn’t
know much about her condition so I was asking her and her daughter
they said that she is already diagnosed with breast cancer since one year
for which she received 8 cycles of chemotherapy and came for the
definitive surgical treatment and we met her hours after her operation.
As regard the mass she said that she found it 1 year ago and I asked if it
was painful or not and she said that it was painless mass accidently
discovered present on the right breast,as regard the size of the mass she
said that it was of the size of a bean. There were not any associated
nipple discharge, pain ,redness or oedema. I asked her about B-
symptoms and she denied presence any of them and her left breast there
were no masses and there were no swelling at any other site to exclude
lymph nodes.
I asked her about any other complaints and symptoms of other systems
affection and it was free, also she patient had no HTN or DM.
She took8 cycles of chemotherapy NACT (AC and taxotere) last one
was on (14/1/2024) and doctor said she was given as she was her2/neu
positive. She denied presence of similar condition in the past, no other
breast diseases and no trauma, infection or surgeries. And she didn’t take
any drugs nor radiotherapy. I didn’t ask her about her obstetric and
menstrual because patient didn’t remember about them.
We asked if there’s any family history if similar condition but it was free
but she said that she has a sister with DM and stroke, and no one in the
family has history of malignancies or breast disease.
I asked to examine her fastly because she had just come out of a total
mastectomy surgery and she agreed,as regard general examination
patient appeared well, she was conscious, cooperative,oriented to time,
place and person,there were no pallor, cyanosis or jaundice with no
special decubitus and she was lying on bed and had a cannula on her left
leg.
Her vitl signs were already registered her pulse was100 bpm,temp:
36.7°C,BP: 120/80 mmHg and Respiratory rate: 17 bpm.
And for local examination by inspection there was a patch on the right
breast the scar couldn’t be exposed it was fresh and painful and there
was a drain at the wound site ,the right breast was completely removed
and the left breast was intact with normal size and shape but palpation
was not done because of patient’s condition.
I thanked the patient and went to ask to see her investigations,
MRI was done and it was free. Bone scan was also free.
Tru-cut biobsy showed grade 2 ductal carcinoma it was ER/PR ,
her2/neu positive and ki-67 positive.
Us and mamogram was done showing mass in the RUOQ , Rt axillary
LN and left suspisious supraclavicular LNs.
Lab : cbc, coagulation profile, virology,LFT,RFT
Tumor marker CA15-3 was high
Surgical ttt was done by modified radical mastectomy of the right breast.
No information about follow up in OCMU with the patient after surgery.