36 year old lactating mother presented two weeks ago with painful right breast of 1 week’s duration . She has been breastfeeding for the past two months until she experienced progressive painful enlargement of the right breast which led her to seek medical attention. Pregnancy and delivery were uneventful .She has no positive family history of breast disease.
Examination : febrile ,ill looking , in obvious pain, Rt breast was tender and had ulcerated with discharge of frank pus. Reactonary axillary lymph nodes on the ipsilateral side
Diagnosis : Breast abscess
Surgery : Incision and drainage
1.Frank pus 300mls
2. Solid mass close to the axilla exicised for histopathology
Intraoperative details : Elliptical incision placed at the maximum point of fluctuancy, ( spanning the upper outer and lower outer quadrants of right breast. Wound closed under vaccum drainage.
Postoperative state : Drain was removed on day 2,fever settled and patient was discharged . She was seen a week later with complaints of severe pain emanating from the right breast. The breast was examined again and found to very tender with advancing cellulitic areas . She was reassured with analgesics and antibiotics and counselled to wear supportive brassiers, to be reviewed at breast clinic in a week with histopathology results.
Histopatology reports : Invasive ductal carcinoma with lymphovascular invasion, Grade III. Hormone receptor status not yet known . Multiple lymph nodes contain tumour cells
Current clinical stage T4b N1 Mx .
Patient is currently going through staging investigations . Updates on this case would be communicated
Credits : Drs Michael Adinku , Charles Appiah , General surgeons, KATH, Kumasi