Concluded Case

Breast lump

48 yr came with c/o rapidly progressive(3cm to 8cm) painless lump in right breast.no other complaint in the same and opposite breast,no symptoms suggestive of distant metastasis.no significant family/personal history. On examination-stable vitals,bmi-27,echog score-1,no axillary lymphadenopathy,10x8cm swelling,mobile over p.major,fixed to skin Biopsy-ducal carcinoma No distant metastasis in abdomen,chest or spine after imaging Staging-cT4bN0M0 I prefer MRM in rural,non motivated women Kindly give your valuable opinion about breast conservation and Onco plastic opinion and chemoradiation in this type of cases

(Edited)

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Concluded answer

MOdified radical mastectomy with chemotherapy

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Large breast tumor fixed to skin Intraductal carcinoma of breast Adv Investigation to look for metastasis - CT scan of chest and abdomen PET CT scan Trucut biopsy of breast tumor to look for ER, PR and HER2 receptor status This patient may be a candidate for neoadjuvant chemotherapy followed by MRM

Thank you sir,we have done usg wa,hrct chest,mri spine-no metastasis.pet ct not avaiable here. Now can we preserve breast in a higher centre or MRM is the choice?Its N0 though
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Breast conservation surgery should not be done in a case of T4 with Skin involvement although N0M0 I think you have chosen the best option of MRM . Radiotherapy and hormonal therapy should also be done depending upon the post operative ER , PR and HER - 2 protein studies

Thank you doctor
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As the lesion is 8cm in size, there would have been micro and macro spread in the other portion of the breast, since patient is already 48 yrs bread conservation is not advisable, hence better to do MRM and clear all the lymphnodes of the axilla, followed by radiation chemotherapy, to keep a watch on distant metastasis.

Thank you doctor
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Modified radical mastectomy advised and follow radiotherapy. Prevention of breast would be a voidable exercise ..

Thank you doctor
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48 yrs lady with painless and rapidly growing tumor with positive ductal carcinoma needs urgent MRM with proper counselling to patient and main attendants in whichever surgical equipped institution available preferably surgical oncologist.If patient is affordable for certain investigations like X-ray chest, ER, PR assessment and PET scan for proper staging.Chemotherapy is started immediately under the guidance of medical oncologist as per staging. Next radiation therapy is also started under care of radiation oncologist. Carcinoma breast is a treatable disease with good prognosis.

Valuable opinion
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As it is diagnosed and staging confirmed a case CA breast with T4N0M0 then it may be taken up for modified radical mastectomy followed by radiotherapy and hormone therapy. Preoperative neo adjuvant chemotherapy if the lump is big to reduce the size. As the size is less than 4inches strightway modified radical mastectomy can be approached. I think preservation of breast is naxt to impossible.

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thanks
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? DUCTAL CARCINOMA .. NEED'S .. ONCOLOGISTS OPINION .. SURGICAL INTERVENTION.. CHEMOTHERAPY.. RADIOTHERAPY..

Thank you doctor
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Looks rt fibroadenoma with Metastasis Opinion of oncologist Biopsy hp

Firstly confirm the diagnosis by Trucut needle Biopsy and IHC panel If malignant Neo adjuvant chemotherapy followed by MRM Further management will depend on the post op Histopathological and IHC report .

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