PBL 3 Case 1 Session 1 by Tharrani Pupathy https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7 en-us 2025-05-17 17:13:28 UTC 2025-05-18 04:57:05 UTC hello@padlet.com Trigger 1 Pewb00m https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220054 2025-05-17 17:17:03 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220054 Trigger 2 Pewb00m https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220209 2025-05-17 17:17:25 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220209 Trigger 3 Pewb00m https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220521 2025-05-17 17:18:06 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220521 Trigger 4 Pewb00m https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220642 2025-05-17 17:18:26 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455220642 T1 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426803 2025-05-18 03:06:12 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426803 T1 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426949

  • 49 YEARS-OLD WOMAN

  • Presented with a lump in her left breast

    1. Common causes of breast lump

      1. Cancer

      2. Cysts

      3. Fibroadenoma

      4. Fibrocystic changes

      5. Coming of period

      6. Mastitis (although not a common cause, requires signs of infections e.g. fever)

      7. Traumatic fat necrosis (inflammation can manifest as lump)

    • ]]>     2025-05-18 03:06:55 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426949     T1 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426969

  • Cancer

  • Cysts

  • Fibroadenoma

  • Fibrocystic changes

  • Coming of period

  • Mastitis (although not a common cause, requires signs of infections e.g. fever)

  • Traumatic fat necrosis (inflammation can manifest as lump)

    • ]]>     2025-05-18 03:07:01 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426969     T1 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426976

  • Presence of pain - X

  • Period pain (lump comes during periods) - X

  • Presence of nipple discharge - X

  • Redness, bleeding? - X

  • Invasion of the nipple (peau d'orange)

  • Skin changes - X

  • Any weight loss? - X

  • When menarche? (Before age of 10) - /

  • Late pregnancy - X

  • History of breastfeeding (increase chances of breast cancer) - X

  • Past medical history

    1. History of trauma? - X

    2. Any past infections - X

    3. Menstrual history (menopause or not) - X

    4. Medications - X

  • Family history

    1. Familial history of breast cancer - /

  • Social history

    1. Alcohol - /

    2. Smoking - /

    3. Occupation (socioeconomic status)

      1. Exposure to contaminants - X

      2. Radioactive - X

      3. High-stress environment - /

    • ]]>     2025-05-18 03:07:02 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455426976     T2 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455435591 2025-05-18 03:32:35 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455435591 T2 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455436760

  • Upper outer quadrant of the left breast (most common, cancer more common in the left breast > right)

  • No nipple discharge, skin changes or alteration in the lump's size (symptoms of malignancy)

  • History of fibrocystic diseases

  • Familial history (BRCA1, BRCA2 genes)

  • No radiation exposure

  • Premenopausal

  • Menarche before age of 10 (increase exposure to estrogen, progesterone and HER2 receptors increased exposure)

  • Patient mother died at age of 45 from breast disease (first degree relative, (BRCA1, BRCA2 genes) plays a critical role in DNA repair)

  • No contraceptives - no family planning

  • Moderate smoking and alcohol - increased risk for carcinoma

  • Lawyer - high socioeconomic status - high educated women are high risk of cancer. (disputed claim)

    • ]]>     2025-05-18 03:34:27 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455436760     T2 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455446227

  • Cancer

  • Cysts

  • Fibroadenoma

  • Fibrocystic changes (Coming of period)

  • Mastitis (although not a common cause, requires signs of infections e.g. fever)

  • Traumatic fat necrosis (inflammation can manifest as lump)

    • ]]>     2025-05-18 04:04:15 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455446227     T2 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455446280 2025-05-18 04:04:27 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455446280 T3 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455446458 2025-05-18 04:05:02 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455446458 t3 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455450563

  • anxious

    • concern about cancer


  • 2cm mass non tender slightly moveable

    • indicate malignant - mobile ,fix to soft tissue


    1. several smaller nodules and ill-defined firm areas were present in both breasts

    • fibrocystic changes

    • metastasis


    1. The nipple and skin appeared normal.

    • early stage

    • easy to detect on early stage


    1. 1.5cm moveable nodule left axilla

    • 5 group for axillary nodes

    • location

    • might need lymph node biopsy

    • axillary clearance

    ]]>     2025-05-18 04:16:47 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455450563     t3 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455450693

  • Cancer

  • Cysts

  • Fibroadenoma

  • Fibrocystic changes (Coming of period)

    • ]]>     2025-05-18 04:17:10 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455450693     t3 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455451910


    • ]]>     2025-05-18 04:20:09 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455451910     t4 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455452123 2025-05-18 04:20:32 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455452123 t4 https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455455266

  • maging studies: A mammogram and ultrasound showed a 25mm irregular mass with stippled calcifications in the upper outer quadrant of the left breast.

    • malignant lesions


  • A core biopsy revealed moderately differentiated invasive ductal carcinoma.


    1. lumpectomy of the left breast with sentinel lymph node

      evaluation

    -

    1. Gross examination of the lumpectomy specimen showed a 20 mm,grey, scirrhous mass in the central portion of the specimen.The margins of the

      lumpectomy specimen were free of a tumour.

    2. Histopathology of the sentinel lymph node revealed metastatic ductal carcinoma

    3. showing two additional positive lymph nodes out of 15

    4. tumour to be oestrogen and progesterone receptors positive with a high proliferative rate and a diploid DNA content.

    5. tumour was HER2 positive.

    • for breast cancer

    1. Adjuvant therapy. The patient was given chemotherapy, radiotherapy and immunotherapy.


    ]]>     2025-05-18 04:28:56 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455455266     LO https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455463588 2025-05-18 04:55:55 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455463588 Reference https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455463897 2025-05-18 04:56:57 UTC https://padlet.com/Pewb00m/rlkwnmnqejvvcxx7/wish/3455463897