Case presentation DR.AHMED KENSARAH

History This is a 60 year old Saudi lady. known case of HTN Hypothyroidism RA C/O Left large ulcerating breast mass.

History History of present illness Lt breast lump 6 years ago Ignored in last 1 year. The mass increased in size Bloody nipple discharge Skin changes Fungating Ulcer

History No Family history of breast cancer No history of benign breast disease or biopsy No history of smoking.

History Age of menarche: 14 Age of menopause : 50 She had her 1st child birth at 30 years of age No History of OCP

Lateral anal sphincterotomy 2 years back Allergies -ve Medication Systemic Review unremarkable Past Surgical History Lateral anal sphincterotomy 2 years back Allergies -ve Medication Thyroxin Mobic Capotin

Physical Examination Vital signs CVS Unremarkable Chest Abdomen

Breast Examination Right breast Left breast Normal with free axilla Enlarged Red Edematous Fungated ulcer Bloody discharge

Left breast Firm Hot Tender Left arm swelling No axillary LN

Investigation Blood work: CBC U&E NORMAL LFT Serum Calcium

Investigation Radiological Mammogram Left breast : was not done . Right breast : Benign prominent ducts.

Investigation Ultrasound : Right: Left : Whole Left breast parenchyma was involved single hypoechoic L.N in the Left axilla measuring 1.8 cm. Right: Normal appreaing parenchyma. Multiple small L.N in the Right axilla .

CHEST X-RAY

CT SCAN CHEST ,ABDOMEN &PELVIS

Bone scan

Histopathology True cut Biposy Invasive Ductal Carcinoma ER/PR Status : +ve HER 2 score : +1

Diagnosis Invasive Ductal Carcinoma . Stage 3 Locally advanced Breast Cancer.

mangement referred to the Oncology. Started on the AC Regimen ( Adriamicin, Cyclophosphamide) 4 cyles, once every 3 weeks . It will be followed by the taxanes for 4 cyles.

mangement Down staging of the tumor for operation. MRM with axillary L.N dissection . Plastic surgery Referral for possible Pectoralis Muscle flap.

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