Case 19: Breast Lump

Mildred Johnson is an 88 year old woman referred to the Breast Surgical Outpatient Clinic by her GP. She has a lump in her left breast.

DSC_0187

HPC

Mrs Johnson is accompanied to the consultation by her daughter Elizabeth who discovered the lump while helping her to try on some new clothes and insisted she attend the GP surgery. Mrs Johnson admitted that she had noticed the lump ‘some months’ before but did not want to worry anyone by mentioning it. She denies any pain and insists that she does not want any treatment but her daughter is very worried and wants the lump to be ‘taken out’ as she had a friend who died from Breast Cancer and is worried that this may be the same problem.

PMH

CABG x4 10 years ago, TIA 8 years ago, HTN, COPD, T2DM, Hypothyroidism, Appendicectomy 70 years ago, OA, Mild short term memory loss

DH

Amlodipine 5mg OD PO

Bendroflumethiazide 2.5mg OD PO

Ramipril 2.5mg OD PO

Tiotropium II OD INH

Salbutamol II INH PRN

Metformin 500mg TDS PO

Levothyroxine 150mg OD PO

Allergies: Penicillin (rash)

FH

Nil

SH

Non-smoker

Occasional ETOH

Widowed and lives on her own in warden-controlled accommodation with daughter close by

Independent with ADLs

Mobilises with stick

O/E

Mrs Johnson is alert and orientated to place, time and person.

She has a non-tender 2x2cm lump in the left breast upper outer quadrant with slight tethering of the overlying skin; the skin itself is normal in appearance. There are palpable non-tender lymph nodes in the left axilla. The right breast/axilla normal.

Question 1:What is the differential diagnosis?

Discuss now on Twitter, using the hashtag #quclms. Follow @quclms for updates. Further information and follow-up questions will appear on Twitter throughout the week.

Question setter & Expert: Miss Pippa Hayes, SpR (ST7) General Surgery 

For tips on following hashtags read more, and try one of our recommended Twitter plugins.

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