Breast lumps differential diagnosis: Difference between revisions

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Revision as of 16:34, 12 January 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Breast lumps must be differentiated from other diseases such as malignancy, cysts, inflammation and non-inflammatory solid lumps.

Breast symptoms such as nipple discharge and mastalgia require assessment as well ^[1].

Differentiating Breast lumps from other Diseases

Differential diagnosis of breast lumps include: ^[1]

Malignancy or breast cancer
- Associated with following factors^[2]:
  - Geographical area
  - Age
  - Ethnicity
  - Positive family history
  - Pathology results such as:
    - Atypical ductal hyperplasia (ADH)
    - Atypical lobular hyperplasia (ALH)
    - Lobular carcinoma in situ (LCIS)
  - Previous history of radiotherapy
Inflammatory lumps:^[3]^[4]
- Associated to personal habit and disease pattern:
  - Infective lumps
    - Lactational mastitis or abscess
    - Non-lactational mastitis
      - Periductal mastitis in chronic smokers
      - Lobular mastitis in tuberculosis and parasitic infection
  - Non-infective lumps such as chronic granulomatous infection
Solid non-inflammatory lumps ^[5] ^[6]
- Related to age, geographical area and ethnicity
- Mostly fibroadenomas in women aged 20-30 years
- Phyllodes tumor are prevalent in various centers, racial groups in different frequencies
Cysts^[7]
- Related to age and usage of hormonal replacement therapy
- Symptomatic cysts are often seen in women age 30 years to early 50 years
- If menopausaed women may be present due to hormone replacement therapy (HRT)

Differential diagnosis of breast lumps
Benign	Palpable breast masses in women between 20 to 50 years old^[8]The most common types of benign breast lumps are^[9]: Fibroadenoma Cysts Fibrocystic changes Galactocele Fat necrosis Breast abscess
Malignant	The most common types are infiltrating ductal breast carcinoma, infiltrating lobular breast carcinoma, mixed of ductal and lobular carcinoma and usually present as a hard mass in breast^[10]

Differentiating Breast lumps from other Diseases

Diseases			Clinical manifestation								Paraclinical findings
			Demography	History	Symptoms			Signs			Lab findings			Imaging
	Benign	Malignant	Demography	History	Mass	Pain	Secretion	Finding 1	Finding 2	Others	Finding 1	Finding 2	Histopathology	Imaging
Fibroadenoma
Phyllodes tumor
Breast cyst
Fibrocystic change
Galactocele
Fat necrosis
Breast abscess
Breast cancer

References

↑ ^1.0 ^1.1 Cheung KL, Lam TP (2005). "Approach to a lump in the breast: a regional perspective". Asian J Surg. 28 (1): 65–70. doi:10.1016/S1015-9584(09)60264-5. PMID 15691804.
↑ Collyar DE (2001). "Breast cancer: a global perspective". J Clin Oncol. 19 (18 Suppl): 101S–105S. PMID 11560983.
↑ Lang AP, Luchsinger IS, Rawling EG (1987). "Filariasis of the breast". Arch Pathol Lab Med. 111 (8): 757–9. PMID 3307689.
↑ Varghese R, Raghuveer CV, Pai MR, Bansal R (1996). "Microfilariae in cytologic smears: a report of six cases". Acta Cytol. 40 (2): 299–301. doi:10.1159/000333755. PMID 8629415.
↑ Alagaratnam, T.T. & Wong, J. World J. Surg. (1989) 13: 743. https://doi.org/10.1007/BF01658425
↑ Shukla HS, Kumar S (1989). "Benign breast disorders in nonwestern populations: Part II--Benign breast disorders in India". World J Surg. 13 (6): 746–9. PMID 2623884.
↑ Leung TN, Haines CJ, Chung TK (2001). "Five-year compliance with hormone replacement therapy in postmenopausal Chinese women in Hong Kong". Maturitas. 39 (3): 195–201. PMID 11574178.
↑ Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW (1998). "Ten-year risk of false positive screening mammograms and clinical breast examinations". N Engl J Med. 338 (16): 1089–96. doi:10.1056/NEJM199804163381601. PMID 9545356.
↑ Morrow M (2000). "The evaluation of common breast problems". Am Fam Physician. 61 (8): 2371–8, 2385. PMID 10794579.
↑ Schoonjans JM, Brem RF (2001). "Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses". J Ultrasound Med. 20 (9): 967–72. PMID 11549157.

Template:WH Template:WS

[pmid15691804-1] 1.0 ^1.1 Cheung KL, Lam TP (2005). "Approach to a lump in the breast: a regional perspective". Asian J Surg. 28 (1): 65–70. doi:10.1016/S1015-9584(09)60264-5. PMID 15691804.

[pmid11560983-2] Collyar DE (2001). "Breast cancer: a global perspective". J Clin Oncol. 19 (18 Suppl): 101S–105S. PMID 11560983.

[pmid3307689-3] Lang AP, Luchsinger IS, Rawling EG (1987). "Filariasis of the breast". Arch Pathol Lab Med. 111 (8): 757–9. PMID 3307689.

[pmid8629415-4] Varghese R, Raghuveer CV, Pai MR, Bansal R (1996). "Microfilariae in cytologic smears: a report of six cases". Acta Cytol. 40 (2): 299–301. doi:10.1159/000333755. PMID 8629415.

[5] Alagaratnam, T.T. & Wong, J. World J. Surg. (1989) 13: 743. https://doi.org/10.1007/BF01658425

[pmid2623884-6] Shukla HS, Kumar S (1989). "Benign breast disorders in nonwestern populations: Part II--Benign breast disorders in India". World J Surg. 13 (6): 746–9. PMID 2623884.

[pmid11574178-7] Leung TN, Haines CJ, Chung TK (2001). "Five-year compliance with hormone replacement therapy in postmenopausal Chinese women in Hong Kong". Maturitas. 39 (3): 195–201. PMID 11574178.

[pmid9545356-8] Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW (1998). "Ten-year risk of false positive screening mammograms and clinical breast examinations". N Engl J Med. 338 (16): 1089–96. doi:10.1056/NEJM199804163381601. PMID 9545356.

[pmid10794579-9] Morrow M (2000). "The evaluation of common breast problems". Am Fam Physician. 61 (8): 2371–8, 2385. PMID 10794579.

[pmid115491572-10] Schoonjans JM, Brem RF (2001). "Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses". J Ultrasound Med. 20 (9): 967–72. PMID 11549157.

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[10]

@@ Line 39: / Line 39: @@
 {| class="wikitable"
 |+Differential diagnosis of breast lumps
-!style="background:#DCDCDC;" align="center" + |[[Benign]]
+! style="background:#DCDCDC;" align="center" + |[[Benign]]
-|style="background:#F5F5F5;" + |Palpable breast masses in women between 20 to 50 years old<ref name="pmid9545356">{{cite journal| author=Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW| title=Ten-year risk of false positive screening mammograms and clinical breast examinations. | journal=N Engl J Med | year= 1998 | volume= 338 | issue= 16 | pages= 1089-96 | pmid=9545356 | doi=10.1056/NEJM199804163381601 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9545356  }}</ref>The most common types of benign breast lumps are<ref name="pmid10794579">{{cite journal| author=Morrow M| title=The evaluation of common breast problems. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 8 | pages= 2371-8, 2385 | pmid=10794579 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10794579  }}</ref>:
+| style="background:#F5F5F5;" + |Palpable breast masses in women between 20 to 50 years old<ref name="pmid9545356">{{cite journal| author=Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW| title=Ten-year risk of false positive screening mammograms and clinical breast examinations. | journal=N Engl J Med | year= 1998 | volume= 338 | issue= 16 | pages= 1089-96 | pmid=9545356 | doi=10.1056/NEJM199804163381601 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9545356  }}</ref>The most common types of benign breast lumps are<ref name="pmid10794579">{{cite journal| author=Morrow M| title=The evaluation of common breast problems. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 8 | pages= 2371-8, 2385 | pmid=10794579 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10794579  }}</ref>:
 *[[Fibroadenoma]]
 *[[Cysts]]
@@ Line 48: / Line 48: @@
 *[[Breast abscess]]
 |-
-!style="background:#DCDCDC;" align="center" + |[[Malignant]]
+! style="background:#DCDCDC;" align="center" + |[[Malignant]]
-|style="background:#F5F5F5;" + |The most common types are infiltrating ductal [[breast carcinoma]], infiltrating lobular [[breast carcinoma]], mixed of ductal and lobular carcinoma and usually present as a hard mass in breast<ref name="pmid115491572">{{cite journal| author=Schoonjans JM, Brem RF| title=Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. | journal=J Ultrasound Med | year= 2001 | volume= 20 | issue= 9 | pages= 967-72 | pmid=11549157 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11549157  }}</ref>
+| style="background:#F5F5F5;" + |The most common types are infiltrating ductal [[breast carcinoma]], infiltrating lobular [[breast carcinoma]], mixed of ductal and lobular carcinoma and usually present as a hard mass in breast<ref name="pmid115491572">{{cite journal| author=Schoonjans JM, Brem RF| title=Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. | journal=J Ultrasound Med | year= 2001 | volume= 20 | issue= 9 | pages= 967-72 | pmid=11549157 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11549157  }}</ref>
 |}
 ==Differentiating Breast lumps from other Diseases==
@@ Line 57: / Line 57: @@
 ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
 ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
+!
+!
 ! colspan="8" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
 ! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Paraclinical findings
@@ Line 62: / Line 64: @@
 ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
 |-
+!
+!
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
@@ Line 69: / Line 73: @@
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
 |-
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Finding 1
+!Benign
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Finding 2
+!Malignant
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Finding 3
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mass
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pain
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Secretion
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Finding 1
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Finding 2
@@ Line 79: / Line 85: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
 |-
-! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hematology
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
-! align="center" style="background:#DCDCDC;" |Differential Diagnosis 1
+! align="center" style="background:#DCDCDC;" |Fibroadenoma
 | align="left" style="background:#F5F5F5;" |
-* Mutation
+|
-* Microorganism
+|
-* Unknown
+| align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" | Any age, more common in males
 | align="left" style="background:#F5F5F5;" |
-* Smoking
+| align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" | +
+| align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |Differential Diagnosis 2
+!
-| align="center" style="background:#F5F5F5;" |
+![[Phyllodes tumor]]
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" |
+!
-| align="center" style="background:#F5F5F5;" | –
+!
-| align="center" style="background:#F5F5F5;" |
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+|-
+!
+! align="center" style="background:#DCDCDC;" |Breast cyst
 | align="center" style="background:#F5F5F5;" |
+|
+|
 | align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" |↑
 | align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
+| align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 |-
-! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cardiology
+!
-! align="center" style="background:#DCDCDC;" |Differential Diagnosis 3
+! align="center" style="background:#DCDCDC;" |Fibrocystic change
 | align="center" style="background:#F5F5F5;" |
+|
+|
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" |±
+| align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" | ↓
+| align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |Differential Diagnosis 4
+!
+! align="center" style="background:#DCDCDC;" |Galactocele
 | align="center" style="background:#F5F5F5;" |
+|
+|
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
-| align="center" style="background:#F5F5F5;" | Nl to ↓
+| align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
 |-
-! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
+!
-! align="center" style="background:#DCDCDC;" |Differential Diagnosis 5
+! align="center" style="background:#DCDCDC;" |Fat necrosis
 | align="center" style="background:#F5F5F5;" |
+|
+|
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 171: / Line 205: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |Differential Diagnosis 6
+!
+! align="center" style="background:#DCDCDC;" |Breast abscess
 | align="center" style="background:#F5F5F5;" |
+|
+|
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 187: / Line 224: @@
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
+|-
+!
+!Breast cancer
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
+!
 |}

Breast lumps differential diagnosis: Difference between revisions

Revision as of 16:34, 12 January 2019

Overview

Differentiating Breast lumps from other Diseases

Differentiating Breast lumps from other Diseases

References

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