![P- 80/min [ taken in right radial artery which is regular/
normo-volumic and there is radio radial or radio
femoral delay].
BP- 150/90 mmHg taken in left brachial artery in supine
position.
e/o pallor(+)
No e/o icterus /cyanosis/clubbing /Edema](https://image.slidesharecdn.com/scc-221201201853-2350d7dc/85/SQUMOUS-CELL-CARCINOMA-10-320.jpg)
![Right hypochondrium lump[1]](https://cdn.slidesharecdn.com/ss_thumbnails/righthypochondriumlump1-210330201334-thumbnail.jpg?width=560&fit=bounds)
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SQUMOUS CELL CARCINOMA
- 1. SQUMOUS CELL CARCINOMA OVER RIGHT GLUTEAL REGION ATUL KUMAR KHARE
- 2. Detail Name : SUKHIYA BAI Age / sex: 58y/F Residence: KATNI MP Occupation: FARMER Religion- Hindu
- 3. Chief complains c/o pain over right gluteal growth -4 months c/o bleeding from growth since 3 months
- 4. HOPI Patient noticed swelling over right gluteal region since 2 years back , 2 years back which not associated with pain, initially it was pea size ,swelling gradually increasing in size . She had c/o pain over swelling since 4 months back when she was injured by falling over ground over swelling. pain was non colicky ,constant and dull aching in nature, insidious in onset ,mild to moderate in intensity, radiating over right lower limb , aggravated by walking and relieved on taking medications and rest. Swelling get ruptured and sero-hemorragic fluid comes out ,after that she developed rapidly increasing ulcerative growth associated with pain and difficulty in standing from sitting position and pain during walking
- 5. c/o loss of weight (45 to 40kg ) last 6 months and loss of appetite (4 chapati to 2 chapati per day). NOT ASSOCIATED WITH = n/o c/o mass coming out per rectum or pruritus. n/o c/o abdominal distension/ jaundice/fever. no c/o cough / hemoptysis. n/o c/o passage of mucus or blood in urine. n/o c/o tenesmus or incontinence. No h/o radiation in past. No h/o fever
- 6. Past history She was p/h/o hypertension since 5 years and patient on medication since then No p/h/o tuberculosis/bronchial asthma /seizures /diabetes mellitus/COPD/ No h/o any chronic medical or surgical illness No h/o radiation in past
- 7. Personal history: Patient taking mixed diet Bladder function are normal. Difficult sleeping pattern due to pain ,for which he takes medication. No history of addiction to alcohol or tobacco. Bladder and bowel habits are normal No allergy or any drug addiction
- 8. Family history No c/o similar complains in any family member or relatives.
- 9. O/E The patient was examined with proper implied consent in adequate light with female assistance. The patient is conscious /oriented to time / place and person. The patient is average in built. Height -140cm weight - 40kg
- 10. P- 80/min [ taken in right radial artery which is regular/ normo-volumic and there is radio radial or radio femoral delay]. BP- 150/90 mmHg taken in left brachial artery in supine position. e/o pallor(+) No e/o icterus /cyanosis/clubbing /Edema
- 11. Per abdominal examination Inspection: The abdomen is exposed from xiphisternum to pubic symphysis which is normal in contour, not distended , no e/o any lump present. All quadrants moves proportionately with respiration .The umbilicus is central and inverted. No e/o any dilated veins /scars/or lymphadenopathy present No cough impulse seen on Hernial orifices. No visible peristalsis seen
- 12. Palpation The findings of inspection are confirmed on palpation. On superficial palpation there in no increase in temperature or tenderness. Abdomen is soft and no guarding /rigidity or any palpable lump present. No inguinal or cervical lymphadenopathy present. There is no Organomegaly , no cough impulse present over the hernial orifices.
- 13. Auscultation Auscultation- No Crepts BL air entry equally present BS+ s1s2+, no murmer present Percussion: Puddle sign negative . Liver span is normal. Tympanic note present over the abdomen.
- 14. Per rectal examination Per rectal examination is done in SIMS position after taking consent and explaining the procedure. on inspection= No e/o any fistula / growth /sentinel pile /any infection present in perianal area on digital examination= Normal anal tone present. No overgrowth present On proctoscopy= No e/o any polyp or haemorrhoid and rest of the anal canal and rectum is normal
- 15. Swelling examination Inspection An 8*6*3 cm ulcerate-proliferative , cauliflower like growth seen over right gluteal region at 3cm below from PSIS, 2 cm supero-laterally from anal verge, 5cm superior from hip joint and 2cm lateral to natal clefts and 8cm above from gluteal fold . Skin around growth found thickened and Endurated . No dilated veins, any scar mark, hyperpigmentation present Shape-irregular cauliflower like Margin- everted Edges- everted Floor-sloughy
- 16. Picture
- 17. Palpation No local rise in temperature Tenderness present Size- around 10*8*4cm Shape- irregular Consistancy -firm to hard No any bony tenderness No any joint involvement
- 18. Fixity Skin Fixity fixed with skin Muscle fixity - Fixed with gluteus maximus - sitting to stand up test positive Bone fixity- not fixed
- 19. Lymph node Examination No inguinal lymph nodes enlargement found
- 20. Summary 58 YEAR OLD LADY PRESENT WITH PAINFUL, RAPIDLY PROGRESSIVE ULCERO-PROLIFERATIVE GROWTH SINCE 4 MONTHS OVER RIGHT GLUTEAL REGION WITH DIFFICULTY IN STANDING FROM SITTING POSITION ON EXAMINATION THERE WAS A LARGE 10*8*4CM ULCERO-PROLIFERATIVE GROWTH PRESENT WITH IRREGILAR SHAPE AND EVERTED EDGES AND MARGINS WITH HIGH VASCULARITY AND SURROUNDING SKIN HAVE THICKENED AND ENDURATED
- 21. PROVISIONAL DIAGNOSIS SQUMOUS CELL CARCINOMA
- 23. THANK YOU