Breast Cancer Case
MF, a 54 year-old female; clinic. She presents with 5 years after completion of adjuvant
chemotherapy for stage IIIA breast carcinoma with a 2-week history of increasing shortness of
breath and cough and mild/moderate pain in left side. Her history of present illness; infiltrating
intraductal adenocarcinoma of the left breast 5 years ago; at that time, ER(-) / PR(-); her-2/neu (+);
p53(+); staged as having T3N1M0, stage IIIA, high-risk breast cancer; underwent a modified
radical mastectomy with axillary node dissection followed by 6 cycles of CMF chemotherapy. In
her past medical history; Gravida 4, para 4; menses onset age13; HTN for 10 years; Type 2 DM for
8 years; breast cancer as above; remained disease free until present follow-up. She had a left
modified radical mastectomy 5 years ago; cholecystectomy 14 years ago as past surgical history.
Her mother and sister have breast cancer. She is take Glyburide 5 mg PO BID, Verapamil SR 240
mg PO QD and Furosemide 40 mg PO QD. She doesn't has any kind of allergy.
Lab. Results :
Na 143 (143), K 4.5 (4.5), Cl 100 (100), HCO3 22 (22), BUN 3.9 (11), Cr 106 (1.2), Uric Acid 286
(4.8), Hct 0.426 (42.6) , Hgb 130 (13), Lkcs 6.8 x 109 (6.8 x 103), Plts 372 x 109 (372 x 103), AST
0.62 (37), ALT 0.5 (30), Alk Phos 1.5 (90), Alb 40 (4.0), LDH 204 (204), T Prot 68 (6.8), T Bili 5.1
(0.5), Glu 7.7 (138), Ca 2.35 (9.4), PO4 1.32 (4.1), Mg 1.1 (2.2), INR 1.0, PTT 22.0 .
Lkc differential: Neut 0.7 (70%), lymph 0.20 (20%), mono 0.065 (6.5%), baso 0.013 (1.3%), eos
0.022 (2.2%).
Urinalysis: WNL.
ECG: normal sinus rhythm.
CXR: Effusion in left lower lobe. Fluid layers out on lateral x-ray.
Bone scan: Multiple metastases to left ribs.
Pleural fluid: Thoracentesis: Glucose 5.3 (95), LDH 234 (234), pH 7.5. specific gravity 1.025,
protein 50 g/L (5.0 g/dL), Lkcs 2.6 x 109, RBC 110 x 1012 (110 x 106); cytology: adencarcinoma
breast.
Physical Examination:
GEN: Well-developed, obese woman in no acute distress.
VS: BP 120/88, HR 80, RR 20, T 37 oC, Ht 167,6 cm, Wt 92 kg.
HEENT: PERRLA, no JVD, no lymphadenopathy.
COR: Normal S1 and S2, no murmurs, rubs, or gallops.
CHEST: Well-healed scar left breast area; dullness of percussion over left lung bases, decreased
breath sounds.
ABD: Obese, soft, nontender, no masses or organomegaly.
GU: WNL
RECT: External hemorrhoids noted.
EXT: No clubbing, cyanosis, or edema.
NEURO: A and O x 3; cranial nerves intact, normal deep tendon reflexes.