Breast Masses
Breast Masses: Excerpt from In a Page: Signs and Symptoms
The occurrence of a new palpable breast mass or a breast lesion on mammography is a common problem in clinical practice. Although breast lumps are a serious concern because of the risk of cancer, most breast lumps and other complaints are of benign origin. Multiple methods are available to differentiate benign from malignant breast lesions, including clinical examination, mammography, ultrasound, fine needle aspiration, and needle core or open breast biopsy. Remember that breast cancers, although rare, can occur in males.
Differential Diagnosis
- Fibroadenoma
–Most common cause of a unilateral discrete breast mass in young women
–May be bilateral and/or multiple
–Common in women with “fibrocystic
changes” of the breast
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Intraductal papilloma
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Fibrocystic changes
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Gynecomastia
- Breast cancer
–Most common cause of discrete mass in women older than 50
–Types include infiltrating ductal (most common), infiltrating lobular, and medullary carcinoma
–Increased incidence with obesity, infertility, late first pregnancy (age >30), uterine cancer, history of breast cancer in first degree relatives (3–10-fold increase), and postirradiation
–Usually presents with nontender breast mass, nipple discharge, or occasionally nipple bleeding
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Galactocele
–Presents during or shortly after breast-feeding
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Cystosarcoma phylloides
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Mammary duct ectasia
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Breast abscess
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Fat necrosis
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Cyst
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Cystic mastitis
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Lymphoma
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Lipoma
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Trauma
Workup and Diagnosis
-
History and physical exam should include breast examination with careful attention to area(s) of mass, supraclavicular and axillary lymphadenopathy, skin changes (e.g., dimpling, edema, erythema, ulceration, or crusting), and nipple discharge
-
Bilateral diagnostic mammogram should be the initial test, but may not be helpful if below age 35 because of high breast density
–Suggestive of malignancy: Increased density, irregular margins, spiculation, irregular microcalcifications
Ultrasound is used as an adjunct to mammography to delineate masses that cannot be seen on mammogram, to determine whether a lesion is solid or cystic, and if age <35
MRI may be considered for indeterminate mammogram or ultrasound
Biopsy of masses, nonpalpable lesions, or suspicious calcifications on mammogram may be indicated
–Fine needle aspiration extracts cells for cytologic examination to distinguish benign versus malignant
–Core needle biopsy of solid lesions or complex cysts extracts tissue and provides a definitive diagnosis
–Excisional biopsy is definitive and may be curative if the full lesion is removed
Perform cytologic assessment of any nipple discharge
Treatment
-
Fibroadenoma
–Requires surgical excision for diagnosis and treatment
–Routine follow up after excision (no increased risk of malignancy)
-
Fibrocystic changes
–Caffeine avoidance is often effective
–Aspirate large or painful cysts
–Vitamin E is used to reduce fibrocystic changes
–Medical therapies (e.g., danazol, oral contraceptives) for pain relief
–Routine follow up is sufficient unless cytologic atypia is present
-
Breast cancer
–Consultation with medical and radiation oncologist
–Surgery, radiation, chemotherapy, and/or hormonal therapy as indicated by stage
Galactocele
–Needle aspiration is usually curative
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Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
More About Fibroadenoma
More Medical Textbooks Online about Fibroadenoma
Review other book chapters online related to Fibroadenoma:
Medical Books Excerpts
- Breast Mass
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: BREAST MASS OR SWELLING (Differential Diagnosis in Primary Care)
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