Muhammad Aslam, Ghulam Sabir Iqbal.
Infiltrating Lobular Carcinoma Breast, A bilateral presentation.
J Rawal Med Coll Jan ;6(2):80-1.

An elderly house wife, a resident of Sargodha, presented with a small lump in the left breast. She gave a history of operation at the site of lump about 4 years back in a peripheral hospital near Sargodha. It was not sent for histopathology. She reported to Military Hospital Rawalpindi with a lump at the operated site, which was of 4 months duration. The respiratory system was normal and there was no hepato splenomegaly. On examination, a 3-cm lump was palpable in the lower outer quadrant of the breast. It was mobile, not fixed with the skin or chest wall. No axillary lymph nodes were palpable. The examination of right breast was un-remarkable at that time. On investigation, her Hb was 9.5gm%. Total and differential leucocyte counts, blood urea, electrolytes, blood sugar and LFT were within normal limits. X-Ray chest did not reveal any abnormality. Ultrasound abdomen was also normal. Bone scan was done, which was negative for secondaries. ; Mammography did not reveal any abnormality in both the breasts. FNAC was suggestive of fibro-fatty tissue. Excision biopsy of the lump was done which was described as `Tissue composed of small to medium size atypical epithelial cells lying in cords and forming Indian-file pattern. Some of the cells have vacuolated cytoplasm showing hyperchromatism.` Opinion was infiltrating lobular carcinoma. Two units of blood were arranged and Modified Radical Mastectomy on left side was done. The patient made an uneventful recovery, the wound healed and she was discharged on 10th post op day and referred to oncologist for any adjuvant chemo or hormonal therapy. She was advised to observe the right breast at regular intervals and to report to this hospital if any lump appeared. After 4 months she reported back with a small lump in the right breast in the upper outer quadrant. Biopsy of this lump was suggestive of invasive lobular carcinoma breast. Patey`s mastectomy was done on the right side as well. Patient is being followed up in the outdoors for any secondaries.

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