breast cancer case study ppt

carcinoma breast case presentation .pptx

This document summarizes the case of a 62-year-old female patient who presented with a lump in her right breast. On examination, a 4 cm irregular, mobile lump was detected. Investigations including mammography and biopsy confirmed a diagnosis of invasive ductal carcinoma. The patient underwent a modified radical mastectomy with axillary clearance. Histopathology of the specimen found grade 2 invasive ductal carcinoma with clear margins and no lymph node metastasis. The final diagnosis was invasive ductal carcinoma of the right breast, stage T2N0M0. Read less

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• 1. Welcome to Clinical Case Presentation Dr. Md. Tafazzul Hossain Bhuiyan IMO SU III DMCH
• 2. A 62 Year Old Female With Breast Lump
• 3. Particulars of the patient • Name: Johura Begum • Age: 62 years • Sex: Female • Address: Shibaloy, Manikgonj • Marital status: Married • Occupation: Housewife • Religion: Islam • Date of admission: 19/09/2022 at 3.30pm • Date of examination: 19/09/2022 at 4.00pm
• 4. Present complaint • Lump in the right breast for 1 month
• 5. History of the present complaint According to the patient’s statement she was relatively well about 1 month back, then she suddenly noticed a lump in upper part of right breast which was gradually increasing in size. She had no pain and fever. She had no history of trauma to the breast. She had no complaint of bone pain, cough, chest pain or weight loss. Her bowel and bladder habit was normal. She did not give history of diabetes, hypertension or contact with TB patient.
• 6. Past medical history • She had no significant past medical or surgical illness
• 7. Drug history • She did not took any medication for this disease
• 8. Family history • Her mother died naturally at old age • She has 2 sisters, none has this type of illness • 1 daughter is in healthy state
• 9. Personal history • She is non smoker, non alcoholic, occasional betel leaf and betel nut chewer Socio economic history • Middle socio economic condition • Lives in brick built house with tin shed roof, use sanitary latrine, drinks safe water from tube well
• 10. Immunization history • She took BCG vaccine at young age • She is vaccinated against COVID19
• 11. Allergic history • She had no history of allergy to any known medication or food. Obstetric history • Married for 50 years • Para 3(NVD) • Menarche at 12 years • Menopause at 40 years
• 12. Breast feeding history • She breast fed her 2 sons and 1 daughter Contraceptive history • She was use to take contraceptive pill irregularly
• 13. General examination • Appearance: normal • Body build: normal • Cooperation: co-operative • Decubitus: on choice • Nutritional status: average(BMI 25.4) • Anemia: absent • Cyanosis: absent • Jaundice: absent • Edema: absent
• 14. General examination (cont) • Dehydration: absent • Clubbing: absent • Koilonychia: absent • Leukonychia: absent • Pulse: 96bpm • BP: 130/80 mmHg • Respiratory rate: 18bpm • Temperature: 98⁰F
• 15. General examination (cont) • Lymph nodes: accessible nodes are not palpable • Thyroid: not enlarged • Skin condition: normal • Bony tenderness: absent
• 16. Local examination Inspection • Both breasts are normal in size and shape • Nipples are normal and symmetrical • No visible lump • No ulcer or peau d’orange or skin tethering • No scar mark, engorged vein • No discharge from nipples
• 17. Inspection • Picture was taken with proper consent of the patient
• 18. Palpation • Left breast: normal and no palpable lump • Right breast: There is a lump in upper and outer quadrant Tenderness: no tenderness Temperature: no local rise of temperature Consistency: hard
• 19. Palpation (cont) Shape: globular Margin: irregular Size: about 4 cm in its maximum diameter Fixity: mobile in all direction and free from underlying structure and overlying skin • Axilla: no palpable nodes in any axilla
• 20. Abdominal examination Inspection • Skin normal • Flanks full • Umbilicus centrally inverted • No scar mark • No visible peristalsis • No engorged veins Palpation • Superficial palpation • Temp: normal • Tenderness: absent • Deep palpation • Lump: no lump felt • Liver: not enlarged • spleen: not enlarged • Kidneys: non ballotable
• 21. Abdominal examination (cont) Percussion • Percussion note: tympanitic • Liver dullness: right 5th intercostal space in mid clavicular line • Shifting dullness: absent Auscultation • Bowel sound: present • Hepatic bruit: absent • Renal bruit: absent
• 22. Other systemic examination Respiratory system • Inspection: normal findings • Palpation: no abnormality seen • Percussion: resonant • Auscultation: breath sound normal, no added sound Cardiovascular system • Inspection: normal findings • Palpation: no cardiomegaly, no palpable thrill or murmur • Auscultation: normal heart sound, no murmur heard
• 23. Other systemic examination (cont.) • Musculoskeletal system: no abnormality or any bony tenderness found • Nervous system: normal • Others systems are apparently normal
• 24. Salient feature Mrs. Johura begum, a 62 years postmenopausal, normotensive, nondiabetic lady was presented with a painless hard lump in upper and outer quadrant of right breast for 1 month. She had no positive family history of any malignant diseases. She had no history of trauma to the breast and no bone pain.
• 25. Salient feature (cont) On examination the lump was about 4 cm in its maximum diameter, margin was irregular, mobile, non tender and no local rise of temperature. There were no skin changes over the lump. There was no nipple discharge. Left breast was normal and there was no axillary lymphadenopathy. Her all vital parameters were normal. Other systemic examination were normal.
• 26. Provisional diagnosis
• 27. Carcinoma right breast (T2N0Mx)
• 28. Differential diagnoses • Phyllodes tumor • Traumatic fat necrosis
• 29. Investigations • Mammography : right breast is predominantly fatty. A radio opaque shadow is seen in upper and inner quadrant of right breast. No micro or macro calcification is noted. Overlying skin and soft tissue appears normal. • Impression: suspicious mass in right breast. Right axillary lymphadenopathy • Category: BIRADS 4
• 30. Mammography
• 31. USG of both breast and axilla • A fairly solid mass lesion with lobulated margin is noted in right breast at 12o’ clock position • No abnormal micro or macro calcifications could be noted • A lymph node <1cm demonstrated in right axillary region • Impression: Right upper mid quadrant (12o’ clock) solid mass with enlarged right axillary lymph node most likely malignant
• 32. USG of both breast and axilla
• 33. Core biopsy and histopathology • Gross: specimen consists of 3 linear pieces of tissues. • Microscopic examination: section shows core of breast tissue. It reveals an invasive ductal carcinoma. The tumor shows mild desmoplastic changes. Nottingham histologic score: 6 • Histologic grade II • Lymphovascular invasion: not identified • Perineural invasion: absent • Diagnosis: Invasive ductal carcinoma, NOS, grade II
• 34. Immunohistochemistry • Estrogen receptor (ER): positive • Progesterone receptor(PR): positive • HER-2: negative • Ki67: immunoreactive in 12% tumor cells
• 35. Histopathology & immunohistochemistry
• 36. Investigations Investigations Date Reports CBC 19/09/22 Hb- 14.1gm/dl, WBC- 12,490/cmm, PLT-216*10^3/mm3 S. glucose 19/09/22 7.2 mmol/l S. creatinine 19/09/22 1.24 mg/dl S. ALT 24/09/22 41U/L S. electrolytes 19/09/22 Na+ 143, K+ 4.6, Cl- 106 mmol/L Blood grouping Rh typing 19/09/22 A+ve ECG 19/09/22 Normal HBsAg and Anti HCV 19/09/22 Negative CXR PA view 19/09/22 Normal study USG of WA 26/09/22 Fatty liver
• 37. Clinical diagnosis • Invasive ductal cell carcinoma (right breast) grade II, NOS (T2N0M0)
• 38. Management • Counselling • Preoperative assessment • Multidisciplinary approach • Operation of the patient • Adjuvant chemotherapy • Rehabilitation and psychological support
• 39. Operation note • Date and time: 28/09/22 at 1.50pm • Name of operation: modified radical mastectomy with axillary clearance of right breast • Indication: Carcinoma of right breast with rt axillary lymphadenopathy • Incision: transverse elliptical incision • Anesthesia: GA
• 40. Operation note (cont) • Findings: a lump present in upper and outer quadrant, right axillary lymphadenopathy • Procedure: with all aseptic precaution proper painting and draping was done. Incision was given. Modified radical mastectomy was done. Axillary clearance was done. Two negative suction drain was kept. Skin was closed. • Specimen sent for histopathology
• 41. • Patient was discharged in 3rd post operative day • With advice to consult with dept of radiotherapy with histopathology report
• 42. Histopathology of specimen • Invasive ductal carcinoma • Grade 2( Nottingham modification of Bloom Richardson system) • Lymphovascular invasion: not identified • Perineural invasion: not identified • Tumor extension: skin: free of tumor • Nipple and areola: free of tumor • Other quadrants: free of tumor
• 43. Histopathology (cont.) • Resection margin: deep resection margin clear • Peripheral resection margin clear • Lymph nodes(17): reactive hyperplasia, no metastasis seen • Pathological staging: pT2N0Mx • Diagnosis: Invasive ductal carcinoma, NST grade 2
• 44. Final histopathology report
• 45. Final diagnosis • Invasive ductal carcinoma (right breast), Grade II, NOS (T2N0M0)
• 46. Thank you

Case Study 63: Cancer of the Female Breast

Dec 21, 2019

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Case Study 63: Cancer of the Female Breast. By Robyn Schwartz. Case Background. 46, premenopausal Dense breasts Has noticed cysts in the past Noticed new lump in upper right quadrant Did not resolve Got bigger Denied lumps in axillary. Patient history. Happily married for 21 years

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Case Study 63: Cancer of the Female Breast By Robyn Schwartz

Case Background • 46, premenopausal • Dense breasts • Has noticed cysts in the past • Noticed new lump in upper right quadrant • Did not resolve • Got bigger • Denied lumps in axillary

Patient history • Happily married for 21 years • 3 kids (3, 8, and 10) • Does breast self exams • Normal pap 2 years ago • Has Asthma and hypertension • Exercises • No tobacco, alcohol or illegal drugs

Risk Factors • All 3 kids born after the age of 35 • First period at 11yr old • Dense breasts • Cysts already develop regularly • Family history of breast cancer • Paternal grandmother diagnosed at age 45 before menopause • Mother diagnosed at age 45 before menopause. Died at age 73 from reoccurrence of breast cancer

Breast Cancer: What is it? • Uncontrolled division of abnormal cells in the breast • Caused by specific mutations • BRCA1 and BRCA2 • TP53

Our patient: Mammogram • 2.3cm x 2.9cm x 3.2cm mass • Irregular borders • Skin thickening • Enlarged axillary lymph node • 6 Y-shaped microcalcifications extended toward nipple • Abnormal mass into pectoral muscle

Grading vs Staging • How far the cancer has spread • I, II, III, IV • Based on • Size of tumor • Invasive vs non invasive • Spread to lymph nodes • Spread to other parts of the body • How abnormal the cells are • 1, 2, 3,4 • Based on • Tubule formation • Size and shape of cells • Mitotic division • Measures the likely aggressiveness of the cells

Grading tumors Nuclear (size/shape) Score 1: little variation in size Score 2: moderate variability, open vesicular nuclei Score 3: lots of variability open nuclei Mitotic Score 1: <7 mitoses Score 2: 8-14 mitoses Score 3: >14 mitoses Tubular differentiation Score 1: > 75% glandular/tubular Score 2: 10-75% glandular/tubular Score 3: < 10% Glandular/ tubular

Staging Cancer • agrdjdytydstasf Stage 0: No Cancer Stage I: IA: Cancer is small, low grade and localized IB: Cancer is large, low grade and localized Stage II: IIA: Tumor is 2-5cm but has not spread IIB: Tumor is 2-5cm but has spread to lymph nodes Stage III: Tumor is larger than 5cm and has spread to multiple lymph nodes Stage IV: Cancer has spread to other parts of the body

Our Patient: Biopsy and ultrasound • Ultrasound: • Non-cystic mass, solid appearing • Abnormal vascularity • Some skin thickening and mild tissue edema • Biopsy: • Consistent with infiltrating breast cancer • 3-5 divisions per high power field • Mild pleomorphism • Positive for estrogen and progesterone receptors

Grade and Stage • Grade 1 • Mitotic score: 1 (<7 divisions) • Glandular Score: 1 (75% glandular) • Nucleic Score: 1 (not much change) • Total score: 3 • 10 year survival rate 90% • Stage IIB • Small • Spread to 1 lymph node • 5 year survival rate of 71%

Our Patient: Treatment • Breast conservation therapy • Lump removal • Radiation • Lymph node biopsy • Tamoxifen • Estrogen receptor blocker • Helps stop growth of cancer cells

Our Patient: Follow Up • 6.5 years cancer free • 80 months later, complained of • bone pain in lower back • Headache

Test Results • Bone scan • Lesions in lumbar spine without fracture • Chest X-Ray • 3 small nodules in upper lobe of left lung • Brain MRI • Small mass in right frontal lobe • Abdominal CT • Negative • Blood tests • CEA elevated by 2-fold • CA27-29 concentration elevated by 2-fold

Diagnosis, Outlook, and Treatment • Stage IV Breast cancer • 13% 10-year survival rate • Treatments • Chemotherapy • taxanes • Hormone Therapy • Targeted therapy • HER2 targeted therapy • Slow growth • Manage Bone Metastasis • Biophosphonates • Slow destruction

How to Prevent cancer • Exercise • Eat well • Don’t smoke • Do regular breast self exams • Report anything suspicious immediately • Check family history

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Case Study 63: Cancer of the Female Breast

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