Right Breast lump hopi from sdas

Reading File

Finding Sources

Reading File

I now have comprehensive content from S Das, Chapter 30 — Diseases of the Breast. Here is the complete structured HOPI for a Right Breast Lump:

HISTORY OF PRESENT ILLNESS (HOPI)

Chief Complaint: Right Breast Lump

(As per S Das — A Manual on Clinical Surgery)

1. PRESENTING COMPLAINT

Mrs. __________, a ____-year-old female, presented to the Surgical OPD with a lump in the right breast of _______ duration.

2. HISTORY OF PRESENTING COMPLAINT

(A) The Lump

Aspect	Points to Ask
Mode of onset	Sudden / gradual; Was it noticed accidentally (while washing/bathing) or due to pain? Was there any preceding trauma?
Duration	Since when has she noticed the lump? (Short history with rapid growth → carcinoma; long history with slow growth → fibroadenoma / fibroadenosis)
Rate of growth	Rapidly increasing in size (malignant) or static/slow (benign)
Site	Which quadrant of right breast (upper outer, upper inner, lower outer, lower inner, central/subareolar)
Size	Approximate size as felt by patient
Number	Single or multiple lumps
Any change over time	Any fluctuation with menstrual cycle

S Das key point: "A lump with a long history and slow growth is a benign condition — either fibroadenosis or fibroadenoma. A lump with a short history and fast growth is probably a carcinoma. The average duration between the patient finding the lump and reporting it to a surgeon is about 6 weeks in case of carcinoma."

(B) Pain

Presence or absence — Carcinoma of the breast is classically painless. A painless lump accidentally found during washing must raise suspicion for malignancy.
Character of pain — Throbbing pain → pus formation (acute mastitis); Cyclical pain aggravated with menstruation → fibroadenosis.
Radiation — Pain at the back, hip, or shoulder in long-standing cases → possible bony metastasis (often mistaken by patient as rheumatism).

"All neoplasms of the breast — either benign or malignant including carcinoma — are painless to start with." — S Das

(C) Nipple Discharge

Present or absent?
Type of discharge:
- Fresh blood / altered blood → duct papilloma or carcinoma
- Pus → mammary abscess
- Milk → lactation, galactocele, mammary fistula (chronic subareolar abscess)
- Serous / greenish → fibroadenosis or mammary duct ectasia

(D) Nipple Retraction

Recent onset → highly significant — suggests underlying carcinoma
Since puberty / long-standing → likely developmental/congenital
Recurrence of abscess may occur with congenital nipple retraction

(E) Skin Changes over the Breast

Dimpling / puckering of skin (Peau d'orange — carcinoma)
Redness, warmth, oedema → acute mastitis
Ulceration over lump

(F) Systemic Symptoms

Weight loss — suggests carcinoma or tuberculosis of the breast
Loss of appetite, easy fatiguability — features of malignancy
Bone pain (back, hip, shoulder) — bony metastasis
Breathlessness / cough → pulmonary metastasis

3. MENSTRUAL HISTORY

Age of menarche
Regularity of cycles
Any relation of lump/pain to menstrual cycle
Menopausal status — post-menopausal lump has higher risk of malignancy

4. OBSTETRIC & LACTATIONAL HISTORY

Parity (nulliparous women → higher risk of fibroadenosis and carcinoma)
History of breast feeding (protective against carcinoma)
Currently lactating? (Acute mastitis / lactational abscess common in first lactation)

5. PAST HISTORY

Similar lump in past (treated / untreated)?
History of breast abscess, TB breast, previous breast surgeries
Carcinoma may recur in the opposite breast — ask about any prior diagnosis/treatment
H/o radiation exposure to chest

6. PERSONAL HISTORY

Marital status — fibroadenosis and carcinoma more common in unmarried/nulliparous women
Dietary habits — diet rich in saturated fatty acids linked to breast carcinoma
H/o oral contraceptive pill use or HRT (hormonal risk factors)

7. FAMILY HISTORY

"Majority of breast diseases including carcinoma often recur in a family." — S Das

H/o breast carcinoma in mother, grandmother, sister, or other first-degree relatives
H/o ovarian carcinoma in family (BRCA1/2 association)

8. SUMMARY STATEMENT (for case sheet)

"Mrs. _______, a ___-year-old [marital status] female, para ___, presented with a painless / painful lump in the right breast since ___ months/weeks, which she noticed accidentally while bathing / due to pain. The lump has been gradually / rapidly increasing in size. There is/is no associated nipple discharge, nipple retraction, or skin changes. She has/has no history of weight loss or bone pain. Her menstrual history is ___. Family history of breast disease is present/absent."

Reference: S Das — A Manual on Clinical Surgery, 13th Edition, Chapter 30: Diseases of the Breast, pp. 414–416

Quick Differential Diagnosis Guide (Based on History)

Feature	Fibroadenoma	Fibroadenosis	Carcinoma	Breast Abscess
Age	<35 yrs	Any (middle-aged)	>40 yrs	Lactating women
Pain	Painless	Cyclical pain	Painless	Severe throbbing
Duration	Slow growth	Slow	Rapid growth	Acute
Nipple discharge	Absent	Serous/greenish	Bloody	Pus
Weight loss	No	No	Yes	No

Create a clinical case sheet template with this HOPI

Reading File

Running Command

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or not foun…

Running Command

mkdir -p /home/daytona/workspace/breast-lump-casesheet

Writing File

~/breast-lump-casesheet/generate.js

const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  ShadingType, Header, PageNumber, NumberFormat, UnderlineType,
  convertInchesToTwip
} = require('docx');
const fs = require('fs');

// ── helpers ──────────────────────────────────────────────────────────────────

const FONT = "Times New Roman";
const FONT_BODY = 11;
const FONT_SMALL = 10;

function heading1(text) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_1,
    children: [new TextRun({ text, bold: true, size: 28, font: FONT, color: "1F3864" })],
    spacing: { before: 240, after: 80 },
    border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: "1F3864" } },
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function heading2(text) {
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}

function heading3(text) {
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    spacing: { before: 160, after: 40 },
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function para(text, opts = {}) {
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    spacing: { before: 40, after: 40 },
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function fieldLine(label, width = 60) {
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function fieldLineShort(label, width = 30) {
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    spacing: { before: 40, after: 40 },
    indent: { left: 200 },
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function checkboxRow(options) {
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    runs.push(new TextRun({ text: "☐ ", size: FONT_BODY * 2, font: FONT }));
    runs.push(new TextRun({ text: `${opt}   `, size: FONT_BODY * 2, font: FONT }));
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        margins: { top: 60, bottom: 60, left: 120, right: 120 },
        verticalAlign: VerticalAlign.TOP,
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    borders: {
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      left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
      right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
      insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
      insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
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}

// ── document content ─────────────────────────────────────────────────────────

const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: FONT, size: FONT_BODY * 2 },
      },
    },
  },
  sections: [
    {
      properties: {
        page: {
          margin: { top: 720, bottom: 720, left: 900, right: 900 },
        },
      },
      headers: {
        default: new Header({
          children: [
            new Paragraph({
              children: [
                new TextRun({ text: "CLINICAL CASE SHEET — DISEASES OF THE BREAST", bold: true, size: 20, font: FONT, color: "1F3864" }),
                new TextRun({ text: "         Page: ", size: 18, font: FONT, color: "888888" }),
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              border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: "1F3864" } },
              spacing: { after: 60 },
            }),
          ],
        }),
      },
      children: [

        // ── TITLE BLOCK ─────────────────────────────────────────────────────
        new Paragraph({
          children: [new TextRun({ text: "CLINICAL CASE SHEET", bold: true, size: 44, font: FONT, color: "1F3864" })],
          alignment: AlignmentType.CENTER,
          spacing: { before: 0, after: 40 },
        }),
        new Paragraph({
          children: [new TextRun({ text: "RIGHT BREAST LUMP", bold: true, size: 36, font: FONT, color: "C0392B" })],
          alignment: AlignmentType.CENTER,
          spacing: { before: 0, after: 40 },
        }),
        new Paragraph({
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          alignment: AlignmentType.CENTER,
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          alignment: AlignmentType.CENTER,
          spacing: { before: 0, after: 200 },
        }),

        divider(),

        // ── SECTION 1: PATIENT IDENTIFICATION ───────────────────────────────
        heading1("SECTION 1: PATIENT IDENTIFICATION"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("IP / OP Number", "________________________________", false),
            tableRow2Col("Date of Admission", "________________   Ward / Bed No.: ________________", true),
            tableRow2Col("Patient Name", "________________________________", false),
            tableRow2Col("Age", "_______ years", true),
            tableRow2Col("Sex", "Female  ☐   Male  ☐", false),
            tableRow2Col("Address", "________________________________", true),
            tableRow2Col("Occupation", "________________________________", false),
            tableRow2Col("Referred by", "________________________________", true),
          ],
          borders: {
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            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        divider(),

        // ── SECTION 2: CHIEF COMPLAINT ───────────────────────────────────────
        heading1("SECTION 2: CHIEF COMPLAINTS"),

        para("Patient presents with:"),
        bullet("Lump in the right breast since _______ (days / weeks / months)"),
        bullet("Pain in the right breast — ☐ Present   ☐ Absent"),
        bullet("Nipple discharge — ☐ Present   ☐ Absent"),
        bullet("Nipple retraction — ☐ Present   ☐ Absent"),
        bullet("Skin changes over breast — ☐ Present   ☐ Absent"),
        bullet("Other: ___________________________"),

        divider(),

        // ── SECTION 3: HOPI ──────────────────────────────────────────────────
        heading1("SECTION 3: HISTORY OF PRESENT ILLNESS (HOPI)"),

        // 3A - Lump
        heading2("3A. THE LUMP"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Mode of onset", "☐ Accidental (while bathing/washing)   ☐ Noticed due to pain   ☐ Following trauma", false),
            tableRow2Col("Duration", "Since: _______ days / weeks / months", true),
            tableRow2Col("Rate of growth", "☐ Rapidly increasing   ☐ Slowly increasing   ☐ Static", false),
            tableRow2Col("Site (Quadrant)", "☐ Upper outer   ☐ Upper inner   ☐ Lower outer   ☐ Lower inner   ☐ Central / Subareolar", true),
            tableRow2Col("Size (as felt by patient)", "Approx. _______ cm", false),
            tableRow2Col("Number of lumps", "☐ Single   ☐ Multiple", true),
            tableRow2Col("Change with menstrual cycle", "☐ Yes (increases premenstrually)   ☐ No   ☐ Not applicable", false),
            tableRow2Col("H/o preceding trauma", "☐ Yes (describe: _____________)   ☐ No", true),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Slow growth + long history → Benign (Fibroadenoma / Fibroadenosis). Rapid growth + short history → Suspect Carcinoma. Average time from discovery to OPD visit in carcinoma = ~6 weeks. (S Das, p. 414)"),

        // 3B - Pain
        heading2("3B. PAIN"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Presence", "☐ Present   ☐ Absent", false),
            tableRow2Col("Character", "☐ Dull aching   ☐ Throbbing   ☐ Sharp   ☐ Cyclical (with menstruation)", true),
            tableRow2Col("Severity (VAS 0–10)", "_______/10", false),
            tableRow2Col("Radiation", "☐ Local only   ☐ Radiates to arm/axilla   ☐ Back pain   ☐ Hip pain   ☐ Shoulder pain", true),
            tableRow2Col("Relation to menstruation", "☐ Aggravated premenstrually   ☐ Constant   ☐ Not related   ☐ Post-menopausal", false),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Carcinoma of breast is PAINLESS. All neoplasms — benign or malignant — are painless to start with. Back/hip/shoulder pain in long-standing cases may indicate bony metastasis. (S Das, p. 415)"),

        // 3C - Nipple Discharge
        heading2("3C. NIPPLE DISCHARGE"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Presence", "☐ Present   ☐ Absent", false),
            tableRow2Col("Type of discharge", "☐ Fresh blood   ☐ Altered blood   ☐ Pus   ☐ Milk   ☐ Serous   ☐ Greenish", true),
            tableRow2Col("Side", "☐ Right   ☐ Left   ☐ Bilateral", false),
            tableRow2Col("Spontaneous / expressed", "☐ Spontaneous   ☐ Only on expression", true),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Blood/altered blood → Duct papilloma or Carcinoma | Pus → Abscess | Milk → Lactation/Galactocele | Serous/Green → Fibroadenosis/Duct ectasia (S Das, p. 415)"),

        // 3D - Nipple Retraction
        heading2("3D. NIPPLE CHANGES"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Nipple retraction", "☐ Present   ☐ Absent", false),
            tableRow2Col("Duration of retraction", "☐ Recent onset   ☐ Since puberty / long-standing", true),
            tableRow2Col("Nipple erosion / Paget's", "☐ Present   ☐ Absent", false),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Recent nipple retraction is significant and usually due to underlying carcinoma. Retraction since puberty is likely developmental. (S Das, p. 416)"),

        // 3E - Skin Changes
        heading2("3E. SKIN CHANGES OVER BREAST"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Dimpling / puckering", "☐ Present   ☐ Absent", false),
            tableRow2Col("Peau d'orange", "☐ Present   ☐ Absent", true),
            tableRow2Col("Erythema / warmth", "☐ Present   ☐ Absent", false),
            tableRow2Col("Ulceration", "☐ Present   ☐ Absent", true),
            tableRow2Col("Engorged veins", "☐ Present   ☐ Absent", false),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        // 3F - Systemic Symptoms
        heading2("3F. SYSTEMIC SYMPTOMS"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Weight loss", "☐ Present (approx. _____ kg in _____ months)   ☐ Absent", false),
            tableRow2Col("Loss of appetite", "☐ Present   ☐ Absent", true),
            tableRow2Col("Easy fatiguability", "☐ Present   ☐ Absent", false),
            tableRow2Col("Bone pain", "☐ Back   ☐ Hip   ☐ Shoulder   ☐ Absent", true),
            tableRow2Col("Breathlessness / cough", "☐ Present   ☐ Absent", false),
            tableRow2Col("Headache / neurological Sx", "☐ Present   ☐ Absent", true),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        divider(),

        // ── SECTION 4: MENSTRUAL HISTORY ─────────────────────────────────────
        heading1("SECTION 4: MENSTRUAL HISTORY"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Age of menarche", "_______ years", false),
            tableRow2Col("Cycle regularity", "☐ Regular   ☐ Irregular", true),
            tableRow2Col("Cycle interval", "_______ days", false),
            tableRow2Col("Duration of flow", "_______ days", true),
            tableRow2Col("Amount of flow", "☐ Normal   ☐ Heavy   ☐ Scanty", false),
            tableRow2Col("Last menstrual period (LMP)", "_______ / _______ / _______", true),
            tableRow2Col("Menopausal status", "☐ Pre-menopausal   ☐ Peri-menopausal   ☐ Post-menopausal (since _____ years)", false),
            tableRow2Col("Relation of lump/pain to cycle", "☐ Increases premenstrually   ☐ No relation   ☐ Post-menopausal", true),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        divider(),

        // ── SECTION 5: OBSTETRIC & LACTATIONAL HISTORY ───────────────────────
        heading1("SECTION 5: OBSTETRIC & LACTATIONAL HISTORY"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Marital status", "☐ Unmarried   ☐ Married   ☐ Divorced / Widowed", false),
            tableRow2Col("Parity (G_P_L_A_)", "G ___   P ___   L ___   A ___", true),
            tableRow2Col("Age at first childbirth", "_______ years   ☐ Nulliparous", false),
            tableRow2Col("Breast feeding history", "☐ Yes, duration: _______   ☐ No", true),
            tableRow2Col("Currently lactating", "☐ Yes (month of lactation: ___)   ☐ No", false),
            tableRow2Col("Oral contraceptive pill use", "☐ Currently using   ☐ Past use (duration: ___)   ☐ Never", true),
            tableRow2Col("Hormone replacement therapy", "☐ Yes (duration: ___)   ☐ No", false),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Nulliparous women and those who have not breastfed are at higher risk of fibroadenosis and carcinoma. Suppurative mastitis is common during the first lactational period. (S Das, p. 414)"),

        divider(),

        // ── SECTION 6: PAST HISTORY ──────────────────────────────────────────
        heading1("SECTION 6: PAST HISTORY"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Previous breast disease", "☐ Abscess   ☐ Fibroadenoma (excised)   ☐ Fibroadenosis   ☐ TB breast   ☐ Prior breast carcinoma   ☐ None", false),
            tableRow2Col("Previous breast surgery / biopsy", "☐ Yes (type: _______________)   ☐ No", true),
            tableRow2Col("H/o radiation to chest", "☐ Yes   ☐ No", false),
            tableRow2Col("Similar symptoms in the past", "☐ Yes (resolved with: _______________)   ☐ No", true),
            tableRow2Col("H/o carcinoma (any site)", "☐ Yes (site: _______________)   ☐ No", false),
            tableRow2Col("H/o DM / HTN / Heart disease", "DM: ☐   HTN: ☐   IHD: ☐   None: ☐", true),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Carcinoma may recur in the OPPOSITE breast. Always ask about contralateral breast history. Fibroadenosis may give recurrent symptoms over years. (S Das, p. 415)"),

        divider(),

        // ── SECTION 7: PERSONAL HISTORY ──────────────────────────────────────
        heading1("SECTION 7: PERSONAL HISTORY"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Dietary habits", "☐ Vegetarian   ☐ Mixed   ☐ Diet high in saturated fat", false),
            tableRow2Col("Smoking", "☐ Smoker   ☐ Ex-smoker   ☐ Non-smoker", true),
            tableRow2Col("Alcohol", "☐ Yes   ☐ No", false),
            tableRow2Col("Sleep", "☐ Adequate   ☐ Disturbed", true),
            tableRow2Col("Bowel & bladder habits", "☐ Normal   ☐ Abnormal (describe: _______)", false),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        divider(),

        // ── SECTION 8: FAMILY HISTORY ─────────────────────────────────────────
        heading1("SECTION 8: FAMILY HISTORY"),

        new Table({
          width: { size: 100, type: WidthType.PERCENTAGE },
          rows: [
            tableRow2Col("Breast carcinoma in family", "☐ Mother   ☐ Sister   ☐ Grandmother   ☐ Other: _______   ☐ None", false),
            tableRow2Col("Ovarian carcinoma in family", "☐ Yes   ☐ No  (BRCA association)", true),
            tableRow2Col("Other cancers in family", "☐ Yes (type: _______________)   ☐ No", false),
          ],
          borders: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            left: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "AAAAAA" },
            insideH: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
            insideV: { style: BorderStyle.SINGLE, size: 2, color: "CCCCCC" },
          },
        }),

        noteBox("Majority of breast diseases including carcinoma recur in a family. Always ask about mother, sister, grandmother. (S Das, p. 415)"),

        divider(),

        // ── SECTION 9: HOPI SUMMARY STATEMENT ────────────────────────────────
        heading1("SECTION 9: HOPI SUMMARY STATEMENT"),

        para("(To be filled after completing the history)"),
        new Paragraph({
          children: [
            new TextRun({ text: "Mrs. ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "_________________________", size: FONT_BODY * 2, font: FONT, color: "AAAAAA" }),
            new TextRun({ text: ", a ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "_______", size: FONT_BODY * 2, font: FONT, color: "AAAAAA" }),
            new TextRun({ text: "-year-old [marital status] female, Para ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "____", size: FONT_BODY * 2, font: FONT, color: "AAAAAA" }),
            new TextRun({ text: ", presented with a ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "☐ painless  ☐ painful ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "lump in the right breast since ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "_______", size: FONT_BODY * 2, font: FONT, color: "AAAAAA" }),
            new TextRun({ text: ", which she noticed ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "☐ accidentally while bathing  ☐ due to pain  ☐ following trauma", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: ". The lump has been ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "☐ gradually  ☐ rapidly", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: " increasing in size. There is ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "☐ no  ☐", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: " associated nipple discharge, nipple retraction, or skin changes. She has ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "☐ no  ☐", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: " history of weight loss or bone pain. Family history of breast disease is ", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: "☐ present  ☐ absent", size: FONT_BODY * 2, font: FONT }),
            new TextRun({ text: ".", size: FONT_BODY * 2, font: FONT }),
          ],
          spacing: { before: 80, after: 80 },
          border: {
            top: { style: BorderStyle.SINGLE, size: 4, color: "CCCCCC" },
            bottom: { style: BorderStyle.SINGLE, size: 4, color: "CCCCCC" },
            left: { style: BorderStyle.SINGLE, size: 8, color: "1F3864" },
            right: { style: BorderStyle.SINGLE, size: 4, color: "CCCCCC" },
          },
          indent: { left: 200, right: 200 },
        }),

        divider(),

        // ── SECTION 10: DIFFERENTIAL DIAGNOSIS GUIDE ─────────────────────────
        heading1("SECTION 10: PROVISIONAL DIFFERENTIAL DIAGNOSIS"),

        para("Based on history, rank the most likely diagnoses:"),
        new Paragraph({
          children: [new TextRun({ text: "1st: ________________________     2nd: ________________________     3rd: ________________________", size: FONT_BODY * 2, font: FONT })],
          spacing: { before: 60, after: 100 },
        }),

        heading3("Quick Differential Guide (From History Alone)"),

        simpleTable(
          ["Feature", "Fibroadenoma", "Fibroadenosis", "Carcinoma", "Breast Abscess"],
          [
            ["Age", "<35 yrs", "Any / middle-aged", ">40 yrs (any age)", "Lactating women"],
            ["Pain", "Painless", "Cyclical pain (premenstrual)", "Painless ★", "Severe throbbing"],
            ["Onset", "Gradual, slow", "Gradual, slow", "Short history, rapid", "Acute"],
            ["Nipple discharge", "Absent", "Serous / greenish", "Blood-stained", "Pus"],
            ["Nipple retraction", "Absent", "Absent", "Recent-onset ★", "Absent"],
            ["Weight loss", "No", "No", "Yes (advanced)", "No"],
            ["Family history", "No", "No", "Often positive", "No"],
          ]
        ),

        divider(),

        // ── SECTION 11: PHYSICAL EXAMINATION REMINDER ────────────────────────
        heading1("SECTION 11: PHYSICAL EXAMINATION CHECKLIST"),

        heading2("General Examination"),
        bullet("Built & nourishment: ______________________"),
        bullet("Pallor / Icterus / Clubbing / Cyanosis / Lymphadenopathy / Oedema"),
        bullet("Pulse: ___ /min   BP: ___/___ mmHg   RR: ___ /min   Temp: ___ °F"),
        bullet("Height: ___ cm   Weight: ___ kg   BMI: ___"),

        heading2("Local Examination of the Breast"),
        heading3("Inspection (Patient in sitting position — compare both breasts)"),
        bullet("Position of breast — any displacement"),
        bullet("Size and shape — symmetry"),
        bullet("Skin changes — dimpling, puckering, Peau d'orange, erythema, ulcer"),
        bullet("Nipple — level, retraction, discharge"),
        bullet("Veins — engorged?"),
        para("Inspect in 4 positions:"),
        subBullet("Arms by the side"),
        subBullet("Arms raised straight above the head"),
        subBullet("Hands on hips — pressing and relaxing"),
        subBullet("Bending forward from waist"),

        heading3("Palpation"),
        bullet("Temperature over lump"),
        bullet("Tenderness"),
        bullet("Lump — position (quadrant), size, shape, surface, margin, consistency, mobility"),
        bullet("Skin over lump — fixity, tethering"),
        bullet("Deep fixity — pectoral fascia / chest wall involvement"),
        bullet("Nipple — expressible discharge"),

        heading2("Regional Lymph Nodes"),
        bullet("Axillary lymph nodes — palpable? Size, consistency, fixity"),
        bullet("Supraclavicular lymph nodes"),
        bullet("Infraclavicular lymph nodes"),

        heading2("Systemic Examination"),
        bullet("Respiratory system — pleural effusion?"),
        bullet("Abdomen — liver enlargement, ascites (metastasis)"),
        bullet("Spine / bony tenderness (metastasis)"),

        divider(),

        // ── SECTION 12: INVESTIGATIONS ────────────────────────────────────────
        heading1("SECTION 12: INVESTIGATIONS PLANNED"),

        heading2("Imaging"),
        bullet("Ultrasound right breast (USG)"),
        bullet("Mammography (age >40 yrs)"),
        bullet("MRI breast (if required)"),

        heading2("Tissue Diagnosis"),
        bullet("FNAC — Fine Needle Aspiration Cytology"),
        bullet("Core needle biopsy"),
        bullet("Excision biopsy (if required)"),

        heading2("Routine Blood Work"),
        bullet("CBC, Blood group & Rh typing"),
        bullet("RBS / FBS, BUN, Creatinine"),
        bullet("LFT, Coagulation profile (PT/APTT)"),
        bullet("Serum CA 15-3 (tumour marker — if malignancy suspected)"),

        heading2("For Staging (if Malignant)"),
        bullet("Chest X-ray (PA view)"),
        bullet("Bone scan / skeletal survey"),
        bullet("CT chest-abdomen-pelvis"),
        bullet("CECT abdomen (liver metastasis)"),

        divider(),

        // ── FOOTER NOTE ───────────────────────────────────────────────────────
        new Paragraph({
          children: [
            new TextRun({ text: "Reference: S Das — A Manual on Clinical Surgery, 13th Edition, Chapter 30: Diseases of the Breast, pp. 414–416.", size: 18, font: FONT, italics: true, color: "888888" }),
          ],
          alignment: AlignmentType.CENTER,
          spacing: { before: 200, after: 40 },
          border: { top: { style: BorderStyle.SINGLE, size: 4, color: "CCCCCC" } },
        }),
        new Paragraph({
          children: [new TextRun({ text: "Template prepared for clinical use — fill in blanks, tick checkboxes, and complete the summary statement after history taking.", size: 18, font: FONT, italics: true, color: "AAAAAA" })],
          alignment: AlignmentType.CENTER,
          spacing: { before: 20, after: 0 },
        }),
      ],
    },
  ],
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync("/home/daytona/workspace/breast-lump-casesheet/RightBreastLump_CaseSheet.docx", buffer);
  console.log("SUCCESS: File written.");
}).catch(err => {
  console.error("ERROR:", err);
  process.exit(1);
});

Running Command

cd /home/daytona/workspace/breast-lump-casesheet && node generate.js 2>&1

Editing File

~/breast-lump-casesheet/generate.js

Error: String not found in file: '        AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  ShadingType, Header, PageNumber, NumberFormat, UnderlineType,
  convertInchesToTwip'

Reading File

Editing File

~/breast-lump-casesheet/generate.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/breast-lump-casesheet/generate.js'

Editing File

~/breast-lump-casesheet/generate.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/breast-lump-casesheet/generate.js'

Running Command

cd /home/daytona/workspace/breast-lump-casesheet && node generate.js 2>&1

Running Command

python /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/worksp…

Running Command

ls -lh /home/daytona/workspace/breast-lump-casesheet/ && file /home/daytona/work…

The file is a valid Microsoft Word 2007+ document (17 KB). Here's your download link:

RightBreastLump CaseSheet

Word Document · DOCX

What's inside the case sheet:

Section	Content
1. Patient Identification	IP/OP No., Name, Age, Address, Referral details
2. Chief Complaints	Checkbox list — lump, pain, discharge, retraction, skin changes
3. HOPI (A–F)	Structured tables for: Lump details, Pain, Nipple discharge, Nipple changes, Skin changes, Systemic symptoms — all with checkboxes
4. Menstrual History	Menarche, cycle, LMP, menopausal status
5. Obstetric & Lactational History	Parity, breastfeeding, OCP/HRT use
6. Past History	Prior breast disease, surgeries, radiation, comorbidities
7. Personal History	Diet, smoking, alcohol
8. Family History	Breast/ovarian carcinoma in first-degree relatives
9. HOPI Summary Statement	Fill-in-the-blank formatted paragraph for case presentation
10. Differential Diagnosis	Table comparing Fibroadenoma / Fibroadenosis / Carcinoma / Abscess
11. Physical Examination Checklist	Inspection positions, palpation points, regional nodes, systemic exam
12. Investigations	Imaging, FNAC/biopsy, blood work, staging workup

All S Das clinical pearls are embedded as highlighted note boxes throughout the document.

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