BREAST MASS OR SWELLING
BREAST MASS OR SWELLING: Excerpt from Differential Diagnosis in Primary Care
Developing a differential of this condition can be done either
histologically or with the mnemonic MINT. After all,
once each structure or
tissue is identified, the significant lesions are either inflammatory or
neoplastic. Let us apply the histologic method.
A skin or subcutaneous mass is most commonly an abscess,
sebaceous cyst, lipoma, or neurofibroma. (For a more detailed discussion of
masses of the skin, see page 396). The
supporting tissue of the breast may be involved by cellulitis, fatty
necrosis, fibromas, or sarcomas. The breast tissue can be inflamed by
bacteria in acute mastitis, obstructed and inflamed on a chronic basis in cystic mastitis,
or diffusely and painfully
swollen bilaterally by drugs (e.g., chlorpromazine and α -methyldopa) or
endocrine disturbances (e.g., pregnancy or Chiari–Frommel syndrome).
Carcinoma of the breast usually forms a nontender, firm swelling in one
breast. Ductal carcinoma presents with a mass and often with a bloody
discharge. Trauma may involve any of the histologic components of the
breast, but the history and physical examination usually make the diagnosis
clear.
Approach to the Diagnosis
When faced with a mass in the breast, the physician’s first step should
be a careful examination of the breasts and the surrounding area. If the
mass is tender, it is likely to be inflammatory or traumatic. If it is not
tender, one should suspect a tumor. If it transilluminates, it is probably a
cyst. Obviously, the primary concern of both physician and patient is
whether the mass is a neoplasm. A careful search for enlarged lymph nodes in
the axilla and the neck or a mass in the other breast is important.
Mammography and ultrasonography are the next most important steps, but a
breast biopsy is still necessary in most cases. A truly cystic mass may be
punctured for fluid analysis and Papanicolaou tests. A biopsy should be
taken of a suspicious mass even if mammography findings are negative.
Other Useful Tests
-
CBC (infection)
-
Culture of discharge (breast abscess)
-
Serum prolactin level (pituitary adenoma)
-
CT scan of the brain (pituitary adenoma)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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