Case Report Writing in Surgery

Case Report Writing

• A case report consists of a clerking sheet and a written report.
• The clerking sheet includes key headings such as PC/PI, HoPC/HoPI, PMH, DH/Allergies, FH, SH, Systems review, Vital signs, Clinical examinations, Differential diagnosis, Plans - investigations, and Plans - management.

Level 4 Evidence: Case Series

• A case report provides level 4 evidence, which is a case series.
• Discussion in a case report should cover why the case is worthy, rare, or controversial, and summarize current literature related to the case.

Conflict of Interest Statement

• A conflict of interest statement ensures transparency and should include financial, personal relationships, and intellectual conflicts.

References

• References should be formatted in line with major journals in the field, such as NLM format.
• There is no specific format required.

Grammar and Plagiarism

• Grammar is as important as content, and poor grammar can lead to misinterpretation.
• Plagiarism is a form of fraud, involving stealing and passing off others' ideas or words as one's own.
• To prevent plagiarism, plan and organize, keep good records of sources, cite sources, paraphrase, and be selective with sources.

Late Submission

• Late submission is not acceptable.
• The new format for Year 3 (2023/24) requires submission in two parts: a clerking sheet and a case report with an originality (similarity) report.
• The originality report is generated using Turnitin software.

Biopsy and Breast Cancer

• Benign excision biopsy is necessary for diagnosis
• Triple biopsy is required for accurate diagnosis
• No margin is left during mastectomy
• Breast oncocentric margin is examined to ensure clear margins

Breast Cancer Types

• DCIS (Ductal Carcinoma In Situ) is a type of breast cancer with a 2mm margin
• Local cancer requires tumour removal (kena potong)
• Phylloides tumor is a type of breast cancer that does not infiltrate skin or muscle and can recur in the same place

Mammogram Findings

• Mammogram can show:
  • Clustered microcalcification
  • Hyperdensity lesion
  • Skin thickening
  • Spiculated margin

Ultrasound Findings

• Ultrasound can show:
  • Heterogenousity
  • Posterior shadowing
  • Axillary lymph node sufficiency
  • Thickened cortex
  • Loss of fatty hilum

Inflammatory Breast Cancer

• Inflammatory breast cancer requires biopsy, MRI breast, or punch biopsy
• Craniocaudal/Medial Oblique Mammogram is used to examine the breast
• Eventhough mammogram can see axilla, do not comment

Tru-Cut Biopsy

• Tru-Cut biopsy is used for immunohistochemistry staining
• Classification of breast cancer is done using Sen-Gillen classification (Luminal A, Luminal B, HER 2A, Enrich, Triple Negative Breast Ca)

Treatment

• Diagnosis → Surgery → Chemotherapy, Radiotherapy → Targeted Therapy
• Neoadjuvant therapy is used depending on St. Gallen classification (for HER 2 or TNBC)

Biopsy Types

• Excisional biopsy is used for malignant cases
• FNAC (Fine Needle Aspiration Cytology) is used for benign cases
• Wedge biopsy is used on the surface of the skin
• Punch biopsy is used for dermis and epidermis

Inflammatory Breast Lump Criteria

• Rapid onset (less than 6 months)
• Occupies 2/3rd of the breast
• With or without nodules

TNM Staging and Treatment

• Need to know TNM staging and treatment for exams

Palpation

• Palpate lower cervical (supraclavicular lymph node) from the back
• Purpose is to palpate the supraclavicular fossa