50 yrs female with painful lump in right breast for last 6 months, Skin of the whole breast is inflamed, Nipple is retracted. Large solitary axillary lymph node present. Comments.


Investigate to rule out inflammatory or malignant swelling

1.CBC,Blood sugar 2.FNAC to find out Chronic inflammatory ( Antibioma) or malignancy. 3.If inflammatory, excision of the mass, antibiotics, antiinflammatory drugs. 4.If malignancy, radical mastectomy and axillary lymphnode clearance.

long duration and age suggests malignancy as first possibility

Probably malignant as the fat planes with surrounding breast tissue appears to be lost, ill defined,heterogeneous. Suggest FNAC

Breast lump with axillary lymph nodes, most probably it could be breast carcinoma, so we need to evaluate in that way. first do mammogram if it is BIRADS CATEGORY 4 onwards go with biopsy and hormonal status ER ,PR &HER2 , ki 67, Then proceed with staging work up , it includes CT scan thorax and abdomen, CBC ,LFT, RFT bone scan SOS.

If this type of presentation comes out to b BIRADS 3 then?

FNAC/CT TO evaluate the inflammation

exclude inflammatory duct carcinoma notoriously advanced malignancies

Would like to keep a differential of inflammatory breast carcinoma in place.. Complete triple assessment. MMG, clinical examination and FNAC it core biopsy. If malignancy, will require metastatic work up. Would not advice upfront surgery for inflammatory breast carcinoma. Kindly update us with the reports..

Clinical examination, mammography and FNAC. Antibiotic+ anti-inflammatory drugs till report comes then plan accordingly

Two possibilities 1.A Benign breast mass with secondary infection 2.CA breast with secondary infection. Investigations adviced 1. FNAC 2 . mammography 3.CT scan to look for secondaries if malignancy Treatment 1.If benign excision of mass with parenteral antibiotics 2 If malignancy, radical mastectomy with axillary clearance

first do FNAC of both the lump and axillary node, based on the report if it is a malignancy grade the tumour and plan for MRM if it is only a inflammatory swelling with a reactionary lymphadenitis then put her on antibiotics if it doesn't resolve and form an abscess proceed with I& D

Some doubts..1.if u think this is malignancy then y do u want to take a fnac from lymph node coz any which way u will do a mrm in this case which includes removal of d ln 2. If u think this is inflammatory then need of fnac from lymph node is not necessary in d acute stage.u can give antibiotics if it resolves then it is inflammatory if it does not then fnac can b done 3.if u think this is malignancy then most probably it will b T4d then y do u want to directly proceed for mrm..is there no role of neoadjuvant CT in this case?
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