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	Hormonal replacement therapy (HRT)	Found in premenopausal, perimenopausal, and postmenopausal women Mostly seen among HRT users	+	±	–	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		+
Galactocele		+
Cysts of montgomery		+
Hemangioma		+
Breast abscess		+
Mastitis	Inflammation Infection	+
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			+
Paget disease			+
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		+
Pregnancy		+
Gynecomastia		+
Premenstrual syndrome		+
Breast trauma		+
Fat necrosis		+
Drugs		+
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

NA