Breast lumps differential diagnosis

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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.

Differentiating Breast lumps from other Diseases

Differential diagnosis of breast lumps include:

Diseases	Etiology	Benign	Malignant	Clinical manifestation									Paraclinical findings			Gold standard diagnosis	Associated findings
				Demography	History	Symptoms			Signs				Lab findings	Histopathology	Imaging
						Mass	Mastalgia	Nipple discharge	Breast exam	Skin changes	LAP	Others
Fibroadenoma	Unknown	+	Very slight increased risk of breast cancer in complex fibroadenoma	Most common benign tumor, women aged 20-30 years	Increased in size during pregnancy or with estrogen therapy, and regress after menopause	+	±	–	Solitary, well-defined mobile mass	–	–	NA	Nl	Proliferative breast lesion without atypia	Well-defined, solid mass	Mammography or ultrasound + biopsy	NA
Breast cyst	Hormonal fluctuation	+	No increased risk of malignancy for simple cyst <1% for complicated cyst <1% to 23% for complex cyst	Cmmon masses found in premenopausal, perimenopausal, and postmenopausal women Mostly seen among HRT users	May resolve after aspiration Further evaluation for not completely resolved masses	+	±	–	Solitary Cluster of small masses or an ill-defined mass Smooth, firm, and frequently tender	–	–	NA	Nl	Nonproliferative breast lesions	simple cyst: Well circumscribed,posterior acoustic enhancement without internal echoes Complicated cyst: Homogenous low-level internal echoes due to without solid components Complex cyst: thick walls greater than 0.5 mm with solid component	Ultrasound Fine needle aspiration (FNA) for confirmation	NA
Fibrocystic change	Unknown Imbalance between estrogen and progestrone	+	No increasd risk of malignancy Slightly increased risk of malignancy in prescence of positive familial history of breast cancer	Unknown prevalence among adolescents >50% in women of reproductive age	Become present before menses and improve during mesturation	+	+	±	Painful breast tissue Tender, nodular swelling	–	–	NA	Nl	Nonproliferative breast lesions	Small cysts in mammary zone Fibroglandular tissue around the mass	Ultrasound Mammography is not recommended for adolescents	NA
Galactocele	Milk duct obstruction	+	No increased risk of malignancy	Milk retention cysts with fluid collection among pregnant women and during breast-feeding	After ending lactation, the cysts resolve	+	±	±	Soft masses Cystic masses	–	–	NA	Nl	Nonproliferative breast lesions	Mammography: Intermediate mass in absence of classic fat-fluid level Ultrasound: Complex mass	Ultrasound Mammography	NA
Cysts of montgomery	Obstruction of periareolar glands of montgomery	+	No increased risk of malignancy	Most common in age of 10-20 years old	More than 80% resolve spontaneously Drainage is essential in rare cases	+	±	±	Asymptomatic subareolar mass Drainage of clear to brownish fluid	±	–	NA	Nl	Nonproliferative breast lesions	Single cystic lesion in retroareolar area	Ultrasound	NA
Hamartoma		+
Breast abscess	Complication of breast mastitis	+	No increased risk of malignancy	Complication of lactational mastitis in 14% of cases Common among African American women, heavy smokers , and obese patients	Drainage Anti-biotic therapy	+	+	–	Localized inflammation of breast Tenderness	+	–	Fever Malaise	Blood culture is required in severe infection	Nonproliferative breast lesions	Fluid collection	Ultrasound	NA
Mastitis	Inflammation Infection	+	No increased risk of malignancy	Common among lactating women (first three months of breast feeding) Periductal mastitis among smokers and associated with squamous metaplasia	Anti-biotic therapy Drainage	±	+	±	Breast tenderness Swollen breast tissue	+	–	Fever Nipple retraction	Leukocytosis	Nonproliferative breast lesions	Ill-defined area with hyperechogenicity with inflamed fat lobules Skin thickening	Ultrasound	NA
Diseases	Etiology	Benign	Malignant	Demography	History	Mass	Pain	Nipple discharge	Breast exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Breast carcinoma			+		Positive family history
Ductal carcinoma in situ			+
Microinvasive breast cancer			+
Breast sarcoma			+
Phyllodes tumor			+
Lymphoma			+
Metastasis			+
Duct ectasia		+
Intraductal papilloma		+
Lipoma		+
Diseases	Etiology	Benign	Malignant	Demography	History	Mass	Pain	Nipple discharge	Breast exam	Skin changes	LAP	Others	Lab findings	Histopathology	Imaging	Gold standard diagnosis	Associated findings
Neurofibroma		+
Gynecomastia		+
Premenstrual syndrome		+
Breast trauma		+
Fat necrosis	Breast trauma Surgical intervention	+	No increased risk of malignancy			+										Ultrasound	NA