Indexing Title: RCHAN’s Medical Anectodal Report [04-2]

MAR Title: Breast CA vs Benign Breast Condition

Date of Medical Observation: January, 2004

Narration:

A 22 year old female married patient who was a sister-in-law of one of our former clerks sought consult due to a gradually enlarging breast mass of 8 months duration at the right upper outer quadrant of the right breast. Patient sought consult with a private MD and an UTZ of the breast was done which revealed a 4 x 3.5 cm solid mass suspicious for malignancy. Patient then sought consult at OMMC. On PE, the mass measured 3 x 4 cm, firm,movable, non-tender, not attached to skin or fascia, no skin dimpling nor nipple retraction was noted. There were no palpable LNs. FNAB was done which revealed atypical ductal cells and an incision biopsy was suggested. The clerk approached me and was very distressed about the results of the work-ups done on her sister-in-law. She could not accept that her sister-in-law has cancer and would have to undergo mastectomy. We referred the patient to Dr. Joson who re-evaluated the mass. His impression was that of a benign breast mass and suggested we do wide excision. The patient underwent the procedure. Grossly the mass was solid, firm,whitish, encapsulated mass measuring 3 x 4 cm with delineated borders. After 1 week the patient came back with a histopath result of fibroadenoma. I explained to her what kind of mass was removed and she was very relieved to find out it was benign and that she didn't have to undergo mastectomy.

Insights (Discovery, Stimulus, REINFORCEMENT):

Patient came in with work-ups for a breast mass which all suggested malignancy. However on physical examination, it was not compatible with malignancy clinically. The patient was a young patient and to do a radical and cosmetically disfiguring operation on her based on her work-ups when the mass presented otherwise with a benign breast condition is not acceptable. It is important to be able to correlate our paraclinical diagnostic procedures clinically.