 Good evening to everybody. I'm Dr. Himanshu, second year post-graduate president in Mahatma Gandhi Medical College and Research Institute Puducherry. The topic of my paper presentation is breast infiltrating or invasive ductal casinoma with lymph node metastasis, a case study. So in India, breast cancer is the most common cancer in females. Last year in 2020, approximately 180,000 breast cancer cases were reported in India that represented approximately 10% of the total. Breast cancer is a heterogeneous neoplasm of cell clones, each of which has its own growth rate and metastatic potential. Now, histological grade is a good predictor of potential cancer disease progression, but as well as axillary lymph node involvement is another significant feature. It is a strong prognostic factor for invasive ductal casinoma. The two hallmarks that determine the progression from breast ductal casinoma in situ to invasive or infiltrating ductal casinoma are the loss of basement membrane and myoepithelial layer, followed by invasion of the tumor cells into the stroma and the surrounding tissues. I came across a case, 54 year old female patient that came with a chief complaint to our hospital with lump in the right breast from past seven months and retraction of nipples since past one month. The patient also presented with breastlessness which aggravated on lying down. The patient had a history of weight loss and she had a positive history of diabetes malitis, hypertension, tuberculosis and epilepsy. On clinical examination, fullness was noted in the right breast, dilated lines were visible, nipple retraction was positive. However, no scar and sinuses were seen whereas the left breast represents normal. On palpation, the right breast was warm, tender and around 8 into 7 centimeter mass was felt, almost covering the entire quadrants, sparing the outer upper quadrant which was 12 to 8 o'clock position. Beauty orange appearance was also noted. So the lump was hard in consistency but there was no discharge from the nipple. Further on clinical examination of the lymph nodes, right side breast was examined first and on the right side breast it revealed the x-ray lymph nodes were examined, they were palpable and a mass measuring 2 into 2 centimeters which was hard in consistency was felt. The right supra-clavicular nodes were also palpable. There were no palpable abnormalities in the left breast. Now coming to the imaging methods, the surgeons ordered ultrasound the first examination so on ultrasound but we saw an ill-defined inhomogeneous predominantly hypoechoic lesion, a hypoechoic large lesion with cleft-like cystic spaces which was seen involving the breast parenchyma from 12 o'clock to 7 o'clock position. The lesion showed internal vascularity on color Doppler study and as well as predominantly solid areas on elastography. The contrast, after that the contrast CT thorax was done that detailed a lobulated heterogeneously enhancing lesion with some necrotic areas within in the right breast retro-areola region extending to the upper and the lower quadrants measuring 6 into 4.5 into 5.5 centimeter. Along with that some multiple satellite lesions were also noted. The largest was measuring, the largest was seen in the lower quadrant along with that numerous enlarged nodes were also noted in bilateral axillary subclavian supra-clavicular as well as right posterior cervical among which the largest was found in the right axilla. So the CT scan report gave as a carcinoma right breast with multiple satellite lesions with nodal metastasis. So this is the CT scans contrast enhanced thorax image that shows a lobulated heterogeneously enhancing mass with necrotic areas within in the right breast involving the retro-areola region. Ultrason guided FNAC of bilateral axillary lymph nodes and right supra-clavicular lymph node was taken and fine needle aspiration revealed features which were consistent with metastatic lymph node. Further to that of the mass which was revealed ultrasound guided core needle biopsy was done which confirmed the features which were consistent with infiltrating or invasive ductile carcinoma. Further to that the patient was found to be ER positive, PR positive and HER2NU negative. So the patient has an, the patient was found to have an invasive or infiltrating ductile carcinoma that is ER positive, ER positive and HER2NU negative. Coming to the discussion, myoepithelial cells are absent in breast invasive ductile carcinoma. Now P63 marker in immunohistochemistry is used to accurately diagnose invasive breast carcinoma. So the P63 positive myoepithelial cells have been shown to surround healthy epithelial lesions in the breast and the carcinomas in C2 have a ring around the epithelial cells. Infiltrative carcinomas have not shown any staining. In this case we did not observe that the axillary lymph node metastatic breast carcinomas examined had any accompanying myoepithelial cells. And coming to the conclusion, the lack of the myoepithelial coating in metastatic infiltrative ductile carcinoma in regional lymph node tends to be close to that of the primary tumor. The tumor grade can however advance to a higher grade or be downgrade to a lower tumor grade in axillary lymph node. Biomarkers, the immunohistochemistry like ERPR and HER2NEW provides a valuable prognostic information for best therapeutic decisions. These are my references. Thank you so much.