Interesting Mammograms #3

Case 1: 44 year old lady with a rapidly enlarging lump in the right breast of 6 months duration. On examination, she had a 3×3 cm hard lump in the lower half of her right breast. Surprisingly, she had a 5×5 cm hard, fixed axillary lymph node.

Reason of sharing this mammogram: bulky axillary lymphadenopathy with the lymph nodes being larger than the primary.

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Case 2: Patient had a lesion in the left breast, which was biopsied. Wanted to point out the steri-strip (artifact) after biopsy.

Pre- biopsy
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Post- biopsy
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Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Interesting Mammogram #2

Case: 45 year old lady that presented with a painless, progressive breast lump on the left side of 7 months duration.

On examination: A10x10 cms firm, mobile lump involving the entire left breast was palpable. There were dilated veins overlying the lump with no palpable axillary lymphadenopathy.

Mammogram is shown below:

image

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Mammogram was suggestive of an encapsulated lesion with smooth margins, probably a phyllodes tumor.

Tru-cut : Phyllodes tumor
HPE: Benign phyllodes

Learning objective: Benign encapsulated tumor on mammogram suggestive of phyllodes. Capsule is visualized as a radiolucent halo around the lump.

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Shocking case – Mastectomy done for an 11 yr old girl!!

Every day brings a new surprise in the life of a doctor but there are some cases which just make you feel angry & helpless and today’s case was exactly the same. Our receptionist had fixed an appointment and when she told me that it is for a 11 year old girl, I probably thought that she is going to turn out be a case of juvenile hypertrophy (enlargement) of the breast but what I saw when I examined the patient left me in a state of shock.

This sweet looking 11 year old kid walked in with her parents and they started telling me the history that she underwent a surgery of the right breast to remove a benign lesion (fibroadenoma) 2 months back and they came to our unit because the girl had noticed another lesion on the left side. Breast surgery at 11 years is usually not recommended as it hampers with the development of the breast during puberty and I immediately knew that something will not be right when I examine the patient. Examination of the girl turned out to be quite shocking. The surgeon (who was actually a gynecologist in a rural set-up) removed not only the lump but also the entire breast tissue on the right side leaving behind just a long scar on the chest (image). It took me a couple of minutes to get in terms with what I was seeing and multiple thoughts started running through my head after that:

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1. My initial reaction was that of anger towards the doctor who had done such a surgery without properly examining the patient or documenting it. Her notes before surgery mentioned no examination findings and the only thing written was ”work-up for surgery”. She had fortunately not examined the other breast, which also had a small lump and I am sure had she examined it, she would have done the same thing on the left side as well.

2. I felt sad for the girl & her parents very well knowing that there is going to be no development of the breast of the right side and the patient will probably have to go for an implant later on in her life.

3. This case reinforced the fact that breast surgery needs to come up as a dedicated branch in India, in order to prevent such cases. Also more awareness needs to be created among people regarding this branch and the fact that it does not deal with only breast cancer. Benign breast diseases are often ignored by patients and they usually approach local doctors for their treatment.

4. This case also reinforced the point regarding proper notes & documentation in all patients. This patient can easily take the doctor who did such a surgery to court and that doctor will have nothing in her defense

5. This case was a real eye opener with regards to the lack of knowledge which general practitioners/ general surgeons / gynecologists have regarding breast disorders and this needs to be addressed by proper refresher courses for these doctors.