LIPOMA

A 52 year old male Mr.Ramasamy, a manual labourer, from Tondiarpet , came with
chief complaints of
Swelling in the left side of nape of the neck for the past 4 years.
History of presenting illness:
Patient was apparently normal 4 years back , then he noticed a swelling in the left
side of nape of the neck
Which was insidious in onset ,
Started as a small swelling of almost a size of almond
Gradually increased in size to attain the present size.
Not associated with pain.
No H/o Fever
No H/o Trauma
No H/o any other swelling
anywhere in the body.
No H/o loss of weight & appetite.
No H/o restriction of movements.
No H/o secondary changes over the swelling.
Past history / Personal history / Treatment history
General examination
Vital Signs
Local examination
Inspection – Solitay swelling in the left side of nape of the neck 8*5 cm ovoid in shape
Extent :
Upper limit: hair line
Lower limit: 2cm above the C7 spine.
Medial limit: just crossing midline
Lateral limit: 2cm from mastoid.
Margins well defined

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 Surface smooth
Skin over the swelling is normal
No punctum,No visible pulsation
No scar. No sinus, no dilated veins
No secondary changes over the swelling
Surrounding area is normal
Palpation:
Not warm ,Not tender
Inspectory findings like site size shape extent are confirmed
Margins are well defined
Surface lobulated,vSoft in consistency
Skin over swelling is pinchable
Plane of the swelling is subcutaneous
Freely mobile in all direction
Slip sign negative
Fluctuation negative
Not compressible or reducible
Not pulsatile or expansile
Regional lymph nodes are not palpable
Other system examination:
Provisional diagnosis :
A case of soft tissue tumour most probably LIPOMA
Investigations
General.
Specific: FNAC
Trucut Biopsy
Treatment :
Excision of the lipoma

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 HYDROCELE
Mr.Elumalai,54 years male,Teynampet who is a Cab driver came with
chief complaints of
Swelling in the left side of the scrotum for the past 5 years.
History of Presenting Illness
Patient was apparently normal before 5 years
He developed a swelling in the scrotal region
Insidious in onset
Slowly progressive to attain the present size
No aggravating and relieving factors
Does not reduce on lying down
No H/o pain
No H/o trauma
No H/o fever with chills and rigor
No H/o heavy weight lifting
No H/o loss of weight
No H/o loss of appetite
No H/o burning micturition
No H/o any other swelling
Past History & Personal history
Family history
Treatment history
General Examination
Vital Signs
Local examination - Inspection
Patient examined in standing position
Left sided scrotal swelling
12*10 cm , Oval in shape
Extends from pubic symphysis to bottom of the scrotum
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 Skin is strecthed and shiny
Rugosity is lost
No dilated veins seen over the scrotum
No ulcer or discharge from the swelling
Cough impulse – negative
Penis in midline
Pubic Hair not seen
Palpation
Patient in standing position
Not warmth ,Not tender
Left sided swelling seen over the scrotum
15*13 cm ,Oval in shape
Extends from root of the scrotum to base of the scrotum
Not reducible
Able to get above the swelling
Fluctuation positive
Trans-illumination positive
Cystic in consistency
Testis not palpable –LEFT SIDE
Right side testis normal
OTHER SYSTEM EXAMINATION
Diagnosis
LEFT SIDED PRIMARY VAGINAL HYDROCELE
Specific Investigation - Ultrasound scrotum
Routine Investigation
Treatment
Jaboulay’s method – eversion of sac
Lord’s plication

4
 SEBACEOUS CYST
Mr.Lakshmanan 34/M from Royapuram who is salesman by occupation came with
Chief complaints of
Swelling in the right side of the forehead for past 3 years
HISTORY OF PRESENTING ILLNESS
The patient was apparently normal before 3 years. Then he noticed a pea sized
swelling in the right side of forehead which has progressed to attain the presentsize

Insidious onset ,
Gradually progressive ,
Not associated with pain or any discharge
No h/o fever
No h/o any other swelling in the body
Past history
Personal history
Family history
General examination
Vital signs
Local examination
Inspection :
A single swelling on the right side of the forehead
approximately 2×2 cm
spherical in shape
surface appears to be smooth
margins – well defined
Extent -: upper limit - 1 cm below hairline
lower limit - 3 cm above right eyebrow
medially - 4 cm from midline
laterally - 7 cm from the ear

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 Skin over the swelling : punctum seen
No hair follicles
No scars , no sinus , no dilated veins , no visible pulsation
Palpation
Not warm , not tender
Inspectory findings are confirmed :A single spherical swelling of size 2×2cm with a
smooth surface and well defined margins on the right side of forehead .
Consistency – cystic, moulding present
Fluctuation – pagets test positive
Transillumination – negative
Skin -not pinchable
Plane of swelling – arises from the skin
Mobility - freely mobile over the underlying structures
No lymph nodes palpable
Other system examination
Provisional diagnosis:
Sebaceous cyst on the right side of the forehead
Management
Investigations
General
Specific - Excision biopsy
Treatment
Complete Excision of the cyst under local anesthesia

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 DERMOID CYST
Mrs. Maheshwari 25/F Home maker From Washermanpet
Presenting complaints:
Swelling in outer corner of Right eye for the past 3 years
History of presenting illness:
Apparently normal before 3 years
Swelling in outer corner of Right eye for the past 3 years
Insidious in onset
Initially pea sized ,slowly progressed to attain current size
Not associated with pain
Not associated with any discharge
No h/o fever
No h/o trauma
No h/o any secondary changes over the swelling
No h/o difficulty in opening eyelids
No h/o defective vision , redness , discharge from eyes
No h/o headache, vomiting, seizures
No h/o loss of appetite , loss of weight
No h/o any other swellings in the body
Past history / Personal history / Family history
General examination
Vital signs
Local examination
Inspection:
Solitary hemispherical swelling of size 5 x 5 cm
Above outer canthus of Right eye
Smooth surface,Well defined margin
Skin over swelling is stretched and shiny

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 Lateral edge of eyebrow lies over the swelling
No punctum over the swelling
No scars, sinuses, dilated veins, ulcerations or visible pulsations
Palpation:
Not warm,Not tender
Hemispherical swelling of size 5 x 5 cm
Surface is smooth,Well defined margin
Skin over the swelling is pinchable , Mobile in both axes
Plane of swelling - subcutaneous
Soft in consistency
Slip sign - negative
Fluctuation test - positive
Transillumination test - negative
Not compressible or reducible
No cough impulse, Not pulsatile
No bony indentation felt
Regional lymph nodes not palpable
Summary
25/F came with a painless, slowly progressing swelling over the outer canthus of
Right eye which on examination was a subcutaneous, smooth, soft, fluctuant,
mobile swelling with no punctum over the surface.
Provisional Diagnosis
A case of dermoid cyst over outer canthus of Right eye
Investigations
Specific
X-Ray skull – AP and Lateral (+/- CT head) & FNAC
General
Treatment
Complete Excision of the cyst

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 SALIVARY GLAND SWELLING
Mr. Masthan Babu 29/M from chepauk who is a tailor came with
CHIEF COMPLAINTS
Swelling below and behind the left ear- 4 years
History of presenting Illness
The patient was apparently normal 4 years back
Then he developed swelling just below and behind the left ear lobule for the past
4 years
Insidious onset,Gradually Progressive
No H/O fever , No H/O trauma
No H/O variation in size of the swelling or pain during meals
No H/O referred pain in the ear
No H/O difficulty in swallowing
No H/O sudden increase in size
No H/O pain over the swelling
No H/O difficulty in opening or closing the mouth or chewing food
No H/O deviation of angle of mouth or difficulty in closing eyelids
No H/O loss of weight, loss of appetite
Past history (recurrence M/c) / Personal history / Family history
General examination
Vital signs
Oral cavity examination
Nicotine stains present
No dental caries ,Tongue moist
Tonsils not enlarged in the left side,Uvula in midline
Local examination
INSPECTION-
A swelling is present in the region of parotid in the left side of
Size 5*3 cm, oval in shape,

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 Surface appears smooth
Skin over the swelling appears reddish and shiny,
Margins - well defined
No dilated veins over the swelling
Retromandibular groove – obliterated
Ear lobule – lifted
PALPATION
Not warm, not tender,Size 5 * 3 cm
Inspectory findings confirmed, Consistency-firm
Extent-superior- just below ear lobule inferiorly upto left angle of mandible
anteriorly-2 cm from tragus & posteriorly- 1 cm from mastoid process
Not fixed to skin ,masseter or bone
Bimanual palpation- deep lobe is not palpable
Bidigital examination-stenson’s duct palpable
FACIAL NERVE - No deviation of angle of mouth
Wrinkles present over forehead
Nasolabial fold – present
Eye closure is normal
Taste sensation – preserved
Examination of mandible- no mandibular thickening
Examination of lymph nodes- Preauricular nodes and neck nodes not palpable
Diagnosis- Pleomorphic adenoma of left parotid gland.
DD - Pleomorphic adenoma / Warthin's tumour Oncocytoma / Mucoepidermoid
carcinoma(low grade)
Specific Investigations
FNAC OF LEFT PAROTID GLAND
CT Scan /MRI
Treatment - Superficial parotidectomy

10
 DIABETIC ULCER
Mr.Subramani 58/M from Porur who is a cook came with Chief Complaints of
Wound in Left leg for 4 weeks
HOPI :Patient was apparentely normal before 4 weeks
Wound in medial aspect of lower half of left leg for 4 weeks
Started as a blister, burst out to become an ulcer ,insidious in onset,
progressive in nature and it has attained present size
H/o yellowish discharge, scanty in amount and foul smelling.
H/o loss of sensation around ulcer
H/o limitation of movements in ankle joint
No h/o pain
No h/o trauma/ fever / burns
No h/o dilated veins
No h/o loss of weigh / loss of appetite
Past History
Personal History
General examination
Vitals
Local Examination - Inspection
Site: ulcer in the medial aspect of distal half of left leg, upper limit extending 20 cm
from tibial tuberosity and lower limit 4 cm from heel and it is 2 and 7 cm medial to
shin of tibia of 20cm×5cm×2 cm
Irregular in shape
Margin: well defined
Edge : sloping
Floor: red granulation tissue
Discharge : scanty serous discharge
Skin hyper pigmented , scaly , edematous, loss of hair , brittle nails.
No varicose veins

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PALPATION
Skin not warm, not tender
Inspectory findings of site, edge and margin are confirmed
Size 22×5×2 cm with indurated margins
Base: bone
Ulcer is not mobile & Does not bleeds on touch
Dorsalis pedis and Posterior tibial artery pulsations are feeble in left leg.
Popliteal pulsations felt in left leg.
Sensation decreased in left foot.
No palpable lymph node
Other system examination
PROVISIONAL DIAGNOSIS - A case of chronic healing diabetic ulcer on the medial
aspect of left leg with neuro-vascular deficit.
DD - Venous ulcer / Arterial ulcer
SPECIFIC:
Discharge C/S ,Edge biopsy
X-ray left leg and foot
BASIC:
Complete hemogram Urine examination Fundus examination
for sugar and ketone
Blood sugar, HbA1C, Electrocardiogram
lipid profile Arterial doppler
Chest X-ray
Renal function test
HbsAg , HIV-ELISA
TREATMENT
Lifestyle modification - diet plan / exercise / weight reduction
Control of blood sugar- insulin, hypoglycemics
Wound debridement, cleaning and dressing of wound
Appropriate Antibiotics Split skin graft
ADVICIE:
Foot care, MCR footwear, Screening for retinopathy, nephropathy& neuropathy
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 SOFT TISSUE TUMOUR
Mr. Kannadasan 57 yrs/M from Kallakurichi a Farmer with CHIEF COMPLAINTS
Swelling in the Back for past 3 years
History of Presenting illness
Patient was apparently normal before 3 years then noticed a swelling in right side
back which was in a pea nut size when he first noticed then it increased in size and it
was operated after 5 months in a private hospital and postoperatively he denied
radiotherapy. Biopsy details are not known.
H/o swelling in the back for past 8 months
which he noticed while bathing ,insidious in onset
which was initially small in size & it rapidly grown to attain present size
associated with pain for 2 months - Continuous,Dull aching type
No aggravating and relieving factors,Not radiating
No H/o Secondary changes like softening, ulceration, fungation
No H/o discharge from the swelling
No H/o restriction of movements
No H/o pressure symptoms
No H/o any other swelling anywhere in the body
No H/o fever,No H/o trauma
No H/o loss of weight and appetite
No H/o chest pain , cough, hemoptysis, headache, jaundice, abdominal pain
Past History – As mentioned above
Personal History/Rx history / Family history / General examination & Vital signs
Local Examination - INSPECTION
Single swelling in the right side of the back approx. 35 x 30 cm globular in shape
Extent :upper limit: spine of scapula
lower limit:15 cm from iliac crest
medial limit: just crossing 1cm frommidline
lateral limit:6 cm from right posterior axillary line

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 Edges: well defined,Previous surgical scar present.
Surface: appears to be smooth except in areas of scar
Dilated veins present,No sinus & visible pulsations
Skin is stretched and shiny & loss of hair over the swelling
Surrounding area also has scar of size 5 cm lateral to swelling
No other swellings present in the body
Palpation
Warm & tender
Single swelling in the right side of the back Size approx. 32 x 29 x 9 cm
Surface is smooth except in areas of scar,Edges are well defined,Firm to hard in
consistency,Not pulsatile
Skin is not pinchable all over swelling
No scar tenderness & discharge
Movement of swelling is restricted in all directions
Plane of swelling: fixed to muscle
Sensation in the surrounding area is normal
Movements of nearby joints is not impaired
Right and left axillary lymph nodes: not palpable
Other system examination
Diagnosis : RECURRENT SOFT TISSUE SARCOMA in the right side of back
Clinical Staging rT2bN0M0(Stage 1b)
Specific Investigations - MRI and TRUCUT BIOPSY
For staging workup: CECT chest,USG abdomen,PET scan
Treatment
After investigations, I will restage & subject this to Multidisciplinary team for
consensus opinion & present this case
Surgery : As it is very large,WIDE LOCAL EXCISION is difficult. So
NEOADJUVANT CHEMOTHERAPY will be given and then will be reassessed for
Surgery

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 ORAL MALIGNANCY
Mr.Thirunavukarasu 43/M from Pudupet a Coolie with Chief Complaints of
Ulcer over left lateral margin of tongue for 6 months.
HISTORY OF PRESENTING ILLNESS:
Patient was apparently normal 6 months back
Developed ulcer over left lateral margin of the tongue
Insidious in onset
Started as a small ulcer opp. to 2nd molar tooth, progressed to attain the present size.
-Associated with pain for past 3 months
- Intermittent in nature
- Pricking type of pain
- Aggravated on taking foods
- No radiation of pain
No h/o difficulty in chewing No h/o halitosis
No h/o difficulty in swallowing No h/o discharge
No h/o difficulty in speech No h/o loss of appetite
No h/o difficulty in opening the mouth No h/o loss of weight
No h/o of excessive salivation No h/o trauma
No h/o inability to protrude the tongue No h/o recent falling of tooth
No h/o deviation of tongue No h/o hemoptysis , pleuritic chest
pain
No h/o alteration of voice
Past history / Personal history (Gutkha/Smoking) / Family history
General examination
Vital Signs
INSPECTION
Lips normal
Nicotene pigmentation on lips
No ulcers / No halitosis / No trismus

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 Dental formula – 2123 2123
2123 2123
Gums normal
Tongue –ulceroproliferative growth 3.5*2cm involving middle part of left lateral aspect
of tongue. Oval In shape with well defined margins and everted edges
Extent - 1 cm from tip of tongue and1cm from midline
Floor - reddish with necrotic tissue
Mobility of tongue not restricted
Buccal mucosa normal
Floor of the mouth normal
Retromolar trigone not involved
PALPATION:
Tender
Ulcer does not bleed on touch
Inspectory findings confirmed
Base - indurated
Mandible - no thickening / irregularity
LYMPH NODE EXAMINATION: No palpable lymph nodes
OTHER SYSTEM EXAMINATION
Diagnosis - CARCINOMA TONGUE TNM STAGING – T2N0M0 (STAGE II )
INVESTIGATIONS :
Imaging – orthopantogram , CECT neck ,
MRI
Punch biopsy
VDRL
Upper gastrointestinal endoscopy
Treatment
Left Hemiglossectomy

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 SKIN MALIGNANCY
Mrs.Anthonyammal 68 /F from Pattabiram a manual worker came with C/o
Ulcer in right side of the head for the past 10 yrs
History of presenting illness
Patient was apparently normal 10 yrs back, then she developed a small ulcer over right
side of scalp which was initially small which gradually increased and attained the
present size
H/o pus discharge from ulcer +
No h/o bleeding.
H/o pain over the ulcer – past 1 month,dull aching,continuous,
No aggravating and releiving factor
not radiating
 H/o itching+
 N/o h/o trauma
 No h/o headache/vomiting/seizures/limb weakness
 No H/o loss of weight or appetite
 No h/o abdominal distension/cough/hemoptysis/bone pain
Past history / Personal history
Family history / Rx History
General examination
Vital signs
Local examination - Inspection
Size 7*7 cm
Shape- Circular,
Extent -3cm away from midline
5 cm above external occipital protuberance
Edge - raised and beaded
Floor of the ulcer is covered with unhealthy granulation tissue & slough
Margin - well defined

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 Hyperpigmentation + over the surrounding skin
No other swelling / ulcers elsewhere
Palpation
Inspectory findings confirmed
An ulcer of size 7*8 cm over right parietal region of scalp,tender
Does not bleed on touch
firm in consistency,
Raised and beaded edges
well defined margins
Restricted mobility
Base indurated
No surrounding induration
No other ulcers/swelling elsewhere
No palpable lymph nodes
Investigations - Specific
Edge wedge biopsy
CT Brain
Routine investigations
PROVISIONAL DIAGNOSIS
A case of Basal cell carcinoma over the right parietal region of scalp
Staging T3N0M0 (Stage 3 )
Differential diagnosis
Squamous cell carcinoma
Keratoacanthoma
Seborrheic keratosis
Treatment
WIDE LOCAL EXCISION(with 1 cm clearance) and flap cover

18
 TESTICULAR TUMOUR
Name: Mr. Ravanaiyaa 35/M from Ponneri, Daily wage by occupation with C/o
Swelling in the right side of scrotum for the past 9 months.
History of presenting illness
Patient was apparently normal 3 months back, after which he developed,
A Swelling occured in the right side of scrotum
Insidious in onset,Progressive in nature
Associated with feeling of heaviness in the scrotum.
Not associated with pain.
No h/o fever,No h/o trauma
No h/o orchidopexy in childhood
H/o breast enlargement for past 3 months,no discharge from the breast
No h/o loss of libido
No h/o any other mass
No h/o vomiting /abdominal pain
No h/o swelling of legs
No h/o breathlessness/hemoptysis
No h/o bony pain
No h/o loss of weight / loss of appetite
Past History
Family History
Personal History
General Examination & Vitals
Local Examination of Scrotum - Inspection
A swelling of size 16x10cm is seen in the right side of the scrotum
Elliptical in shape
Extent is from root to the bottom of scrotum.
Skin over the swelling is normal,No scar,sinus or dilated veins
No visible cough impulse.
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 Scrotal skin rugosity reduced
Pubic hair shaved,Penis in midline
Palpation
Not warm, not tender.
Inspectory findings are confirmed.
Hard in consistency.
Fluctuation – Negative
Transillumination – Negative
Able to get above the swelling.
Comparatively right testis feels heavy.
Testis is not palpated separately from the swelling
Testicular sensation is absent.
Epididymis and spermatic cord – normal
Left side testis is normal
Penis is in midline and normal
No regional lymph nodes palpable.
Other system Examination
Differential Diagnosis
Testicular tumour
Chronic Hematocele
Chronic hydrocele
Specific investigation
Testicular tumour markers – LDH ,HCG ,AFP
Ultrasound scrotum
Testicular biopsy – Inguinal approach
Routine Investigations
Metastatic workup – X ray chest/ CT chest/ CT abdomen
Treatment - Orchidectomy / Radiotherapy / Chemotherapy

20
 UNDESCENDED TESTIS
Mr. Prakash 19 years / Male College Student from Royapuram Came with
Chief Complaints
Absence of right testis since birth.
Swelling in the right inguinal region for the past 6 months
Pain in the swelling for past 1 week.
History of presenting illness
H/O swelling in the Right inguinal region for past 6 months
Insidious in onset ,Progressive in nature
H/O pain in the right inguinal region which is intermittent, dull aching,aggravated on
walking and relieved on compression
No H/O swelling in root of penis, thigh and perineum.
No H/O chronic cough
No H/O constipation or difficulty in micturation
No H/O previous surgeries
No H/O blood transfusions
Past history
Personal history
Family history
General examination
Vital signs
Local examination - Inspection
Swelling of size 8*4 is seen on the Right inguinal region
Pyriform in shape
Extends 7 cm from ASIS to groin
Surface is smooth
Skin over the swelling is normal
Cough impulse present
No scar or sinuses
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 Scrotum is well developed on left side and poorly developed on Right side

Palpation
Not warmth, non tender.
Deep ring occlusion test – swelling does not appears. cough impulse felt.
Right sided testis is not palpable in the scrotum.
Left sided testis is palpable.
Penis is normal.
No organomegaly.
Other system Examination
Diagnosis
A case of right sided undescended testis associated with right sided incomplete
indirect inguinal hernia.
Specific Investigation
To find out the location of testis
Ultrasonogram of inguinal region & scrotum
Routine investigations
Treatment
ORCHIDOPEXY
Adequate mobilisation of the testis and spermatic vessels.
Ligation of the associated hernial sac.
Adequate fixation of the testis in the dependent portion of the scrotum.

22
 CA PENIS

Mr.Moorthy 42 year old male from Thiruvallur working as a security came with
complaints of
Ulcer Over The Penis For Past 5 Months
History of presenting illness
The patient was apparently normal before 5 months. Then he developed,
Ulcer over the penis for the past 5 months
Insidious in onset,progressive in nature
not associated with pain
The ulcer was initially in the inner prepuce and now it had grown to
involve the whole of Glans.
H/O Discharge from the ulcer for the past 15 days
Purulent in nature
Associated with foul smell,not blood stained
No H/O Trauma
No H/O Fever
No H/O Burning micturition
No H/O Micturition difficulties
No H/O Hematuria
No H/O Loss of weight /Loss of appetite
No H/O Bone pain/ Jaundice /Breathlessness
Past history
Personal history
Family history / Rx History
General examination
Vital signs
Local examination - Inspection
SITE- Glans Penis,SIZE 4X3 cm,Irregular in shape
Margins- ill defined,Edge- raised and everted

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 Floor- unhealthy tissue
External urethral meatus is seen.
Surrounding area- edematous.
Dilated veins seen in dorsum of penis
1x1 cm ulcer present on the ventral surface of penis
Palpation
Not tender
Inspectory findings are confirmed
size – 4x3 cm.
The ulcer extends from 5 cm from the
root and involves the whole of glans.
Irregular in shape ,Base of ulcer- indurated
induration extends 1cm beyond the margin
The ulcer does not bleed on touch
Examination of lymph nodes
Right inguinal region- Node of size 1x1cm, non-tender, firm in consistency, mobile.
Left inguinal region- Node of size 1.5x1cm,non-tender, firm in consistency, mobile.
Other system Examination
Specific investigation
Wedge biopsy of the ulcer.
FNAC of lymph nodes.
Routine and Staging investigation (Chest x-ray & USG and CT abdomen)
Diagnosis
A case of non-healing ulcer involving glans penis with bilateral palpable inguinal
lymph nodes probably Carcinoma Penis at stage III.

Treatment - Partial penectomy with oral antibiotic therapy for the inguinal lymph nodes
for 3 weeks to exclude infective etiology. If the nodes have not resolved at end of 3
weeks to proceed with inguinal node dissection.

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 FIBROADENOMA

Mrs. Saritha Devi 24 Year old, coming from Moolakadai, working in an export company
came with chief complaint of Lump in the Right breast for the past four months.

History of Presenting illness:

Patient was apparently normal before 4 months. Then she noticed a lump in the Right
breast while taking bath. Duration of 4 months.
Insidious in onset,Slowly progressed to attain present size.
Not associated with pain.
No history of trauma.
No history of fever.
No history of discharge from nipple.
No history of nipple retraction.
No history of loss of weight or loss of appetite
No history of bone pain.
No history of jaundice.
No history of breathlessness and cough with hemoptysis.
Past history (? Recurrence )
Personal history
Family history / Rx History
General examination
Vital signs

Local examination of Breast – Inspection (After consent/Privacy/Exposure)

Patient in sitting position with arms by side of the body.
Rt Breast is normal in position, size and shape on comparison with the opposite
breast.
No visible lump on inspection.

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 Skin over the breast is Normal,
No scars,No dilated veins,No dimpling, No ulceration
No peau d’orange appearance
Nipple – Single, normal in position, size and shape. No cracks or fissures.
Areola – Normal in colour and size. No cracks/fissures.
Arms and Thorax – Normal
Supraclavicular region – No fullness.
Patient with arms raised above the head:
Both breasts rises equally,No puckering
Inframammary region seen
No retraction of nipple,No peau d’orange appearance.
Patient on leaning forward :
Breasts fall equally on both sides.
Palpation :
Not warmth,Not tender.
A single lump in the upper outer quadrant of the Right breast.
Size of 3x3 cms.,globular in shape.
Surface is smooth.Margins are regular, well-defined.
Firm in consistency.
Intrinsic mobility is present.
Not fixed to skin/Underlying Muscles/Chest wall
No palpable axillary lymph nodes.
Diagnosis - A case of Fibroadenoma in the upper outer quadrant of the Right breast.
Specific investigations
Fine needle aspiration Cytology
Ultrasound
Routine Investigations
Treatment : Excision biopsy.

26
 GANGLION CYST
A 25 year old Female MS.SHYLA ,coming from Korukkuppet , came with chief
complaints of
Swelling in the right wrist for the past 6 months.
History of presenting illness:
Patient was apparently normal before one year. Then she developed a swelling in
the right wrist for which she was injected once following which the swelling subsided.
After 6 months , the swelling recurred in the same site.
It was insidious in onset
Started as a small swelling gradually progressed to attain the present size.
Not associated with pain.
No H/o fever
No H/o trauma
No H/o any other swelling anywhere in the body.
No H/o loss of weight & appetite.
No H/o restriction of movements.
No H/o secondary changes in the swelling
Local examination:
INSPECTION
Single swelling on the Lateral aspect of the right wrist joint 1.5x1cm in size spherical
in shape well defined margins

Surface : smooth
Skin over the swelling is normal
No visible pulsation
No scars,sinus or dilated veins
No secondary changes over the swelling
Palpation:
Not warm ,Not tender
Inspectory findings like site size shape surface are confirmed

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 Margins are well defined
Skin over swelling is pinchable
Surface is smooth
Tensely cystic in consistency
Mobility : Mobile only on the horizontal axis
Vertical Mobility is restricted normally and when the wrist joint is extended
Slip sign negative
Fluctuation is positive.
Transillumination is positive.
Not compressible or reducible.
Regional lymph nodes are not palpable
No neurovascular deficit
Provisional diagnosis :
A case of ganglion in the right wrist
Specific USG
General Investigation
Treatment
Excision biopsy

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