41 year old lady with a left breast lump since last 6 years with rapid increase in size since the last 4 months. Patient was concerned that she is suffering from breast breast cancer and therefore got a mammography done and presented to my clinic.
A tru- cut biopsy was done and it revealed it to be a phyllodes tumor, which after resection turned out to be a malignant phyllodes tumor with Liposarcomatous differentiation.
Case uploaded by:
Dr. Rohan Khandelwal
Breast Cancer Surgeon
W Pratiksha Hospital, Gurgaon
47 year old lady with complaints of bilateral breast pain since 3 months. Pain was non cyclical and relieved by oral paracetamol. She had a hysterectomy 6 years back and she was a known asthmatic.
On examination, she has multiple tender nodules in both the breasts, localised in the peri-areolar region.
Mammogram revealed multiple, well defined, rounded densities in both the breasts with a rim of calcification around them (refer to figures).
Multiple round densities in the breast
Ultrasound done revealed dense fibroglandular tissue with multiple sub-centimetric cysts in the breasts.
Differential – 1. Multiple oil cysts with calcification
2. Cysts secondary to fibroadenosis
Case managed by:
Dr Rohan Khandelwal
Consultant, Department of Breast Diseases and Cancer Care
W Pratiksha Hospital, Gurgaon
With the increase in opportunistic screening of Breast Cancer in India, more and more impalpable breast lesions are being detected. Wire guided localisation is one method to surgically deal with these lesions.
This video highlights the operative steps of wire guided localization and also the use of a specimen mammogram.
Dr. Rohan Khandelwal
Consultant, Breast Onco-surgeon
W Pratiksha Hospital
1. Type of superficial thrombophlebitis (inflammation of the veins_ which involves the veins of the anterior chest wall & breast
2. Presents like a painful, cord like structure just below the breast (image)
3. Most commonly involved vein is the lateral thoracic vein. Other veins involved are – thoraco-epigastric & rarely superficial epigastric
4. Clinical features – pain along the lateral chest wall and below the breast. Patients may also complain of a cord like structure. Some patients present with just breast pain and the cord is detected by the breast surgeon
5. Benign, non cancerous lesion, which is self-limiting
6. Management – Consult a breast surgeon and get imaging done to rule out any other breast lump.
7. Treatment involves warm compresses and anti-inflammatory medicines. It usually resolves in 4-6 weeks.
Pic Courtesy: http://www.cosmeticsurgeryforums.com
Breastfeeding has been known to reduce the risk of breast cancer and this effect is more pronounced in pre-menopausal women.
In an analysis of 47 studies, mothers who breastfed for a total duration of more than one year (all pregnancies combined) had a lower chance of developing breast cancer as compared to those who never breastfed.
Mothers who breastfed for more than two years got about twice the benefit as compared to those who breastfed only for one year.
In the last week, I have seen two patients who have presented with features of a breast abscess but they ultimately turned out to be breast cancers. Although, inflammatory breast cancers are a known entity and they can present as breast abscesses but this fact is not well known among patients and many general practitioners, which leads to late detection of these cancers.
With this case, I want to highlight some pointers to diagnose these lesions early. A 39 year old, non lactating mother presented to with complaints to swelling in the right breast for the last 3 weeks. She had already taken a course of antibiotics from a general practitioner but did not get relieved of her symptoms. On examination, she had a swelling involving the skin fold below the breast (infra-mammary crease) with swelling and hardness spreading till the lower part of the breast. In addition to this, she had lymph nodes (glands) in the underarm area (axilla) as well.
An USG revealed a lump in the breast associated with fluid collection, which on biopsy turned out to be an invasive cancer. Fortunately for the patient, on further examination, the cancer was found to be restricted to the breast and the underarm area only.
When should we suspect that a breast abscess can actually be associated with a malignancy (cancer)?
- A non healing breast abscess – which is persisting despite antibiotics and surgical management
- Breast abscess in a patient who is not lactating.
- Breast abscesses in elderly patients
- Breast abscesses associated with hard lumps in the breast
Patients with these symptoms should get an ultrasound and biopsy done to confirm the diagnosis. In India, another entity which should be ruled out is Breast Tuberculosis.
Yesterday, we had the privilege of meeting the Delhi CM, Mr. Arvind Kejriwal, regarding the idea of conducting breast cancer screening in the upcoming ‘mohalla’ clinics in Delhi.
The AAP government is planning to launch 1100 mohalla clinics by the end of this year and a major thrust in these clinics will be early detection of cancers.
Mr. Kejriwal & Mr. Satyendra Jain analysed a novel breast cancer screening device, which has been manufactured by UE Lifesciences and they agreed to carry out a pilot project using this device in some of their mohalla clinics.
I was personally impressed to see the CM already aware of the burden of breast cancer in our country and I admire his vision to screen patients for this dreaded condition.