Case sheet proforma for History taking and Examination of Breast Lump.

Name: 

Age/Sex: 

Occupation: 

Socioeconomic Status:

Presenting Complaints

• Lump in the right/left breast for last………….. months/years.

---

Also Read:

• TOP BOOKS TO STUDY CLINICAL SURGERY

• BEST BOOKS TO READ DURING YOUR GENERAL SURGERY RESIDENCY

• THYROID CASE SHEET PROFORMA

• UNDERSTANDING SKIN INVOLVEMENT IN CA BREAST: T4B

• WHAT IS THE REASON FOR PUCKERING OR SKIN RETRACTION IN BREAST CANCER?

---

History of Presenting Illness

• H/O Lump

• Site

• Duration

• Onset

• Progress of the swelling:

• Associated

• H/O Pain

• Site

• Duration

• Onset

• Character: Usually dull-aching

• Radiation

• Relieving factors 

• Aggravating factors

• H/O Ulcer

• Site

• Duration

• Onset

• Progress of the ulcer

• Associated

10/24/2020 03:49:00 PM

Phyllodes Tumor

• The term Phyllodes originates from Greek word "phullon" which means a leaf.
• It is also called as Cystosarcoma phyllodes.
• Here is a picture of a Phyllodes tumor recently operated by us. 
• The patient was a 38 year old female with complaints of swelling in Left breast of 6 months duration which was fast growing in size.
• The tumor was excised through a submammary incision
• Phyllodes tumors are a fibroepithelial tumor composed of an epithelial and a cellular stromal component. 
• They may be considered benign, borderline, or malignant depending on histologic features including stromal cellularity, infiltration at the tumor's edge, and mitotic activity
• Predominantly a tumor of adult women
• Very fast-growing, and can increase in size in just a few weeks
• 10% of patients with phyllodes tumours can develop distant metastases 
• Commonest sites for distant metastases are the lung, bone, and abdominal viscera.
• Treatment : Wide Local Excision

6/24/2020 07:03:00 PM

Case History

A 32 year old female came with multiple lumps in her right breast which have been there from past 7 years and are increasing in size and number. Initially she was advised conservative management and observation. But the lesions were growing in size and she had started having occasional pain. So she decided to go for surgical removal.

Discussion: What is the best incision if multiple fibroadenomas have been identified?

Having multiple fibroadenomas in a single breast is a rare occurrence.

There are various available incision approaches like: 

• Periareolar
• Inframammary
• Radial
• Curvilinear. 

Each of these having their advantages and disadvantages. Utilising the mobility of the fibroadenomas, allows them to be excised through a single cosmetic circumareolar incision in each breast. Periareolar incision is not suitable when the diameter of the tumor is >5 cm or when the distance between the tumor and the areola is >3–4 cm, since the surgery would cause significant damage to the lactiferous ducts (Zhao XY).

Traditional surgical incision often chooses radial incision or curvilinear incision on the surface of the tumor. It is very favorable for the exposure and resection of the tumor, and the treatment effect is also good, but the postoperative scar is obvious and affects the cosmesis.

References

http://journals.sagepub.com/doi/abs/10.4137/BCBCR.S9512

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1524-4741.2001.007003189.x

http://file.scirp.org/Html/5-2101137_57749.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103926/

Zhao XY. Application value of areola incision at the edge of the benign breast tumor resection. Zhongguo Shiyong Yiyao. 2010;5:57–58

5/04/2018 11:01:00 AM

What is Skin Involvement or T4b ?

Edema (including peau d’ orange) or ulceration of the skin of the breast or satellite skin nodules confined to the breast.

What is not Skin Involvement or T4b ?

Dimpling of the skin and nipple retraction is not considered skin involvement.

Skin involvement in breast showing a skin nodule 

surrounded by edema (peau d orange)

How does peau d’ orange appearance develop?

Localised edema (peau d’orange) develops when drainage of lymph fluid from the skin is disrupted by infiltration of lymphatics by metastatic cells.

-----------------------------------------------------------------------------------
Read more about Ca Breast:

WHAT IS THE REASON FOR PUCKERING OR SKIN RETRACTION IN BREAST CANCER?
http://www.worldsurgeryforum.net/2016/05/what-is-reason-for-puckering-or-skin.html

SKIN PUCKERING AND PEAU D ORANGE APPEARANCE IN BREAST CANCER
http://www.worldsurgeryforum.net/2016/05/skin-puckering-and-peau-d-orange.html

WHAT IS THE ACCURACY OF CLINICAL DETERMINATION OF AXILLARY LYMPH NODE METASTASIS IN CA BREAST?
http://www.worldsurgeryforum.net/2016/06/what-is-accuracy-of-clinical.html

MECHANISM OF METASTASIS FROM CA BREAST TO BATSON'S PLEXUS AND LIVER
http://www.worldsurgeryforum.net/2016/06/mechanism-of-metastasis-from-ca-breast.html

6/12/2016 02:39:00 PM

The clinical stage of breast cancer is determined primarily through physical examination of the skin, breast tissue, and regional lymph nodes (axillary, supraclavicular, and internal mammary). The clinical determination of axillary lymph node metastases has an accuracy of:

1. Only 80%
2. Only 50%
3. Only 33%.
4. Only 10%

Answer in the comment section below. Detailed explanation will be posted.

6/08/2016 12:19:00 PM

A) Puckering/ Skin Retraction B) Peau d' Orange appearance

A) Shows skin retraction/ puckering
More than 80% of breast cancers show productive fibrosis that involves the epithelial and stromal tissues. With growth of the cancer and invasion of the surrounding breast tissues, the accompanying desmoplastic response entraps and shortens Cooper’s suspensory ligaments to produce a characteristic skin retraction. 

B) Shows peaud’orange appearance
Localised edema (peau d’orange) develops when drainage of lymph fluid from the skin is disrupted    

5/26/2016 09:56:00 PM