Breast Lump

PRESENTER : DR SAHANA M
2ND YEAR POST-GRADUATE
GENERAL SURGERY DEPARTMENT
KVGMCH
MENTOR : DR SIDDHARTH P DUBHASHI,
PROF. AND HOD OF GENERAL
SURGERY
AIIMS, NAGPUR
Personal details:
•Name : Mrs. A
•Age : 52 years
•Gender : Female
•Occupation : Labourer

•Address : Arakalgodu

•Date of admission : 19th November 2020

•Date of examination : 20th November 2020
Chief Complaint:
Lump in the left breast since 2months
History of present illness:
• Patient complains of lump in the left breast since 2 months, noticed
while bathing, it was initially of size 2x2cm and has rapidly progressed
to the present size of 6x6cms. It is not associated with pain. No
history of preceding trauma.
• History of nipple retraction present- since 15days
• No history of nipple discharge
• No history of similar lump in opposite breast/both axillary region
• No history of backache
• No history of yellowish discolouration of eyes/skin/urine
• No history of breathlessness/cough/haemoptysis
• No history of headache/seizures
• No history of use of hormonal replacement therapy

• No history of Diabetes Mellitus, Hypertension, Tuberculosis, Asthma,

Epilepsy
Past History:
• No history of Tuberculosis
• No history of use of oral contraceptive pills
• No history of breast biopsy
• No history of irradiation
Family History
• No history of similar complaints in her family
• No history of BRCA related malignancies like prostatic, ovarian,
colorectal cancer in her family.
Menstrual History:
• Age at menarche: 13years
• Previous cycles: Regular-3-5/30days cycle
• Age at Menopause: 48years
Obstetric History:
Age at marriage: 18years
P2L2- both full term vaginal delivery (Both children are male, alive and
healthy)
She conceived her first child at the age of 19years and she breastfed
her first child for 1 year
She conceived her second child 2years after the delivery of first child
and breastfed her second child for 1 and half years.
Personal History:
• Mixed diet
• No history of smoking/alcohol consumption
• No history of loss of appetite/weight
• Sleep: Undisturbed
• Bowel and Bladder habits- normal and regular
Physical Examination:
GENERAL SURVEY
• 52 year old female patient conscious, cooperative and well oriented
to time, place and person
• Moderately built and nourished(BMI-22.7)
• Temperature: 98.4 F
• BP: 100/70mmHg
• PR:96 bpm
• RR: 15/min
• No pallor/icterus/ cyanosis/clubbing/pedal oedema
• Left anterior axillary group of lymph node palpable
Examination of left breast:
(After taking consent, patient examined in sitting position with arms by her side)

INSPECTION
• Fullness visible over left breast in the left upper outer quadrant
• Left nipple- circumferential retraction present and appears to be drawn towards
the upper outer quadrant which gets prominent on raising her arms above head
• No nipple discharge
• No dimpling/puckering/Peau de orange/ulceration
• No engorged veins
• Axillary and supraclavicular fossa- appear normal

PALPATION
(Patient examined in sitting, semi-recumbent and later on in recumbent
position)
No local rise of temperature
A lump is palpable in the left breast in the upper outer quadrant extending
into upper inner quadrant, measuring 6x5cm, irregular surface and borders,
hard in consistency, non tender. It is fixed to the breast tissue. It is not fixed
to the skin/pectoralis major.
• On pressing the nipple from either side, it could not be everted and
there was no nipple discharge on pressing of the tumor.
Examination of lymph nodes:
• Axillary group of lymph nodes:
-Anterior axillary group: 1 lymph node palpable, hard in
consistency, mobile and non-tender
-Other group of lymph nodes- nonpalpable

• Supraclavicular lymph nodes: non-palpable

Examination of right breast: normal
Examination of right axillary and supraclavicular lymph nodes: not
palpable

Per vaginal examination: normal

Per rectal examination: normal

Examination of skeletal system: no bony tenderness

Systemic Examination:
• Respiratory system: No evidence of pleural effusion

• Abdominal examination: No hepatomegaly/ascites

• Central nervous system: No focal neurological deficit

• Cardiovascular system: S1S2 present. No murmurs.

Summary:
A postmenopausal woman with history
of painless lump in the left breast since 2
months with recent onset nipple
retraction. On examination, a lump is
palpable in the upper outer quadrant
extending into upper inner quadrant of
left breast-6x5cms, with irregular surface
and borders, hard, non tender with fixity
to breast tissue and an ipsilateral axillary
group of lymph node is palpable-hard,
non-tender and mobile.
Diagnosis:
• Ca left breast- T3N1M0- Stage III A
Investigations:
• Routine:
Hb, TC, DC, ESR, Blood grouping and typing, blood sugar, blood urea,
creatinine, Routine urine examination, ECG, HIV, HbsAg, BT, CT

• Specific:
Mammography
FNAC/Trucut biopsy
• Chest Xray
• USG Abdomen and pelvis
• Liver function test
• CT Scan of chest, abdomen and brain
Treatment:
Neoadjuvant chemotherapy+MRM+ adjuvant
chemotherapy+radiotherapy
THANK YOU