1. Case presentation
DR.AHMED KENSARAH

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

3. 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

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

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

6. 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

7. Physical Examination
Vital signs
CVS
Unremarkable
Chest
Abdomen

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

9. Left breast
Firm
Hot
Tender
Left arm swelling
No axillary LN

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

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

12. 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 .

13. CHEST X-RAY

15. CT SCAN
CHEST ,ABDOMEN &PELVIS

45. Bone scan

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

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

49. 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.

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

51. THANK YOU