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Causes of Fibrocystic breasts

Contents
  1. Fibrocystic breasts: Introduction
  2. Excerpts from book chapters
  3. Related cause information

Fibrocystic breasts Causes: Book Excerpts

Related information on causes of Fibrocystic breasts:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Fibrocystic breasts may be found in:

Causes of Fibrocystic breasts: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Fibrocystic breasts.

Breast Masses: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • 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
  • Intraductal papilloma
  • Fibrocystic changes
  • 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
  • Galactocele
    –Presents during or shortly after breast-feeding
  • Cystosarcoma phylloides
  • Mammary duct ectasia
  • Breast abscess
  • Fat necrosis
  • Cyst
  • Cystic mastitis
  • Lymphoma
  • Lipoma
  • Trauma

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Breast Pain & Discharge: Differential Diagnosis
(In a Page: Signs and Symptoms)

Breast pain

  • Fibrocystic change
    –Most common benign breast condition
    –Clinically present in 50% and histologically in 90% of women
  • Mastitis
    –Associated with lactation
  • Extramammary causes of pain (e.g., cervical radiculitis, costochondritis, herpes zoster, angina)
  • Breast cancer
    –Occurs in 1/9 women (lifetime risk)
  • Cyst
  • Breast abscess
  • Unilateral or bilateral gynecomastia
  • Phylloides tumor
  • Intraductal papilloma
  • Fat necrosis
  • Trauma
  • Fibroadenoma
  • Lipoma
  • Pregnancy
    Breast discharge
  • Duct ectasia
  • Galactorrhea
  • Mondor's disease
  • Chronic nipple stimulation
  • Pregnancy
  • Hypothyroidism
  • Sarcoidosis
  • Systemic lupus erythematosus
  • Cirrhosis or other hepatic disease
  • Breast cancer
    –Occurs in 1/9 women (lifetime risk)
  • Intraductal papilloma
  • Fibrocystic change
  • Medications (e.g., phenothiazines, metoclopramide, tricyclic antidepressants, reserpine, opiates, cimetidine, androgens)
  • Hypothalamic and pituitary abnormalities (e.g., prolactinoma, acromegaly, empty sella syndrome)
  • Pseudocyesis

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Breast nodule [Breast lump]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Adenofibroma. The extremely mobile or “slippery” feel of this benign neoplasm helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn't cause pain or tenderness, can vary from pinhead size to very large, commonly grows rapidly, and usually lies around the nipple or on the lateral side of the upper outer quadrant.

❑ Areolar gland abscess. Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also be pres-ent.

❑ Breast abscess. A localized, hot, tender, fluctuant mass with erythema and peau d'orange typifies an acute abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. With a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It's commonly accompanied by skin dimpling, peau d'orange, nipple retraction and, sometimes, axillary lymphadenopathy.

❑ Breast cancer. A hard, poorly delineated nodule that's fixed to the skin or underlying tissue suggests breast cancer. Malignant nodules typically cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant.

Nodules usually occur singly, although satellite nodules may surround the main one. They're usually nontender. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings include edema (peau d'orange) of the skin overlying the mass, erythema, tenderness, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.

❑ Fibrocystic breast disease. The most common cause of breast nodules, this fibrocystic condition produces smooth, round, slightly elastic nodules, which increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren't fixed to underlying breast tissue, they don't pro- duce retraction signs, such as nipple deviation or dimpling. Signs and symptoms of premenstrual syndrome — including headache, irritability, bloating, nausea, vomiting, and abdominal cramping — may also be present.

❑ Mammary duct ectasia. The rubbery breast nodule in mammary duct ectasia, a menopausal or postmenopausal disorder, usually lies under the areola. It's commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; thick, sticky, multicolored nipple discharge from multiple ducts; and nipple retraction. The skin overlying the mass may be bluish green or exhibit peau d'orange. Axillary lymphadenopathy is possible.

❑ Mastitis. With mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d'orange as well as a high fever, chills, malaise, and fatigue.

❑ Paget's disease. Paget's disease is a slow-growing intraductal carcinoma that begins as a scaling, eczematoid unilateral nipple lesion. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Breast pain [Mastalgia]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Areolar gland abscess. Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also occur.

❑ Breast abscess (acute). In the affected breast, local pain, tenderness, erythema, peau d'orange, and warmth are associated with a nodule. Malaise, fever, and chills may also occur.

❑ Breast cyst. A breast cyst that enlarges rapidly may cause acute, localized, and usually unilateral pain. A palpable breast nodule may be present.

❑ Fat necrosis. Local pain and tenderness may develop in fat necrosis, a benign disorder. A history of trauma usually is present. Associated findings include ecchymosis; erythema of the overriding skin; a firm, irregular, fixed mass; and skin retraction signs, such as skin dimpling and nipple retraction. Fat necrosis may be hard to differentiate from cancer.

❑ Fibrocystic breast disease. Fibrocystic breast disease is a common cause of breast pain that's associated with the development of cysts that may cause pain before menstruation and are asymptomatic afterward. Later in the course of the disorder, pain and tenderness may persist throughout the cycle. The cysts feel firm, mobile, and well defined. Many are bilateral and found in the upper outer quadrant of the breast, but others are unilateral and generalized. Signs and symptoms of premenstrual syndrome — including headache, irritability, bloating, nausea, vomiting, and abdominal cramping — may also be present.

❑ Mammary duct ectasia. Burning pain and itching around the areola may occur, although ectasia is commonly asymptomatic at first. The history may include one or more episodes of inflammation with pain, tenderness, erythema, and acute fever, or with pain and tenderness alone, which develop and then subside spontaneously within 7 to 10 days. Other findings include a rubbery, subareolar breast nodule; swelling and erythema around the nipple; nipple retraction; a bluish green discoloration or peau d'orange of the skin overlying the nodule; a thick, sticky, multicolored nipple discharge from multiple ducts; and axillary lymphadenopathy. A breast ulcer may occur in late stages.

❑ Mastitis. Unilateral pain may be severe, particularly when the inflammation occurs near the skin surface. Breast skin is typically red and warm at the inflammation site; peau d'orange may be present. Palpation reveals a firm area of induration. Skin retraction signs — such as breast dimpling and nipple deviation, inversion, or flattening — may be pres-ent. Systemic signs and symptoms — such as high fever, chills, malaise, and fatigue — may also occur.

❑ Sebaceous cyst (infected). Breast pain may be reported with sebaceous cyst, a cutaneous cyst. Associated symptoms include a small, well-delineated nodule, localized erythema, and induration.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Breast cancer: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The cause of breast cancer isn't known, but its high incidence in women implicates estrogen.

Certain predisposing factors are clear; women at high risk include those who have a family history of breast cancer, particularly first-degree relatives (mother, sister, and maternal aunt).

Other women at high risk include those who:

❑have long menstrual cycles or began menses early (before age 12) or menopause late (after age 55)

❑have taken hormonal contraceptives

❑used hormone replacement therapy for more than 5 years

❑who took diethylstilbestrol to prevent miscarriage

❑have never been pregnant

❑were first pregnant after age 30

❑have had unilateral breast cancer

❑have had ovarian cancer — particularly at a young age

❑were exposed to low-level ionizing radiation.

Recently, scientists have discovered the BRCA1 and BRCA2 genes. Mutations in these genes are thought to be responsible for less than 10% of breast cancers. However, these discoveries have made genetic predisposition testing an option for women at high risk for breast cancer.

Women at lower risk include those who:

❑were pregnant before age 20

❑have had multiple pregnancies

❑are Native American or Asian.

Most breast cancer deaths occur in women age 50 and older (84% of cases), and 77% of new breast cancer cases occur in this age-group. However, it may develop any time after puberty. It occurs in men, but rarely; male cases of breast cancer account for less than 1% of all cases.

The 5-year survival rate for localized breast cancer has improved because of earlier diagnosis and the variety of treatments now available. According to the most recent data, mortality rates continue to decline in White women and, for the first time, are also declining in younger Black women. Lymph node involvement is the most valuable prognostic predictor. With adjuvant therapy, 70% to 75% of women with negative nodes will survive 10 years or more compared with 20% to 25% of women with positive nodes.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Mastitis and breast engorgement: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Mastitis develops when a pathogen that typically originates in the nursing infant’s nose or pharynx invades breast tissue through a fissured or cracked nipple and disrupts normal lactation. The most common pathogen of this type is Staphylococcus aureus; less frequently, it’s S. epidermidis or beta-hemolytic streptococci. Rarely, mastitis may result from disseminated tuberculosis or the mumps virus. Predisposing factors include a fissure or abrasion on the nipple; blocked milk ducts; and an incomplete let-down reflex, usually due to emotional trauma. Blocked milk ducts can result from a tight bra or prolonged intervals between breast-feedings. Causes of breast engorgement include venous and lymphatic stasis, and alveolar milk accumulation. (See Physiology of lactation, page 982.)

Mastitis occurs postpartum in about 1% of pregnant women, mainly in primiparas who are breast-feeding. It occurs occasionally in nonlactating females and rarely in males. All breast-feeding mothers develop some degree of engorgement, which isn’t an infectious process.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Breast nodule [Breast lump]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adenofibroma

The extremely mobile or “slippery” feel of an adenofibroma—a benign neoplasm—helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn’t cause pain or tenderness, can vary from pinhead size to very large, often grows rapidly, and usually is located around the nipple or on the lateral side of the upper outer quadrant.

Areolar gland abscess

A tender, palpable abscess on the periphery of the areola caused by an infection and inflammation of Montgomery’s glands. Fever may also be present.

Breast abscess

A localized, hot, tender, fluctuant mass with erythema and peau d’orange typifies an acute abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. In a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It’s commonly accompanied by skin dimpling, peau d’orange, and nipple retraction and sometimes by axillary lymphadenopathy.

Breast cancer

A hard, poorly delineated nodule that’s fixed to the skin or underlying tissue suggests breast cancer. Malignant nodules commonly cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant of the breast.

Malignant nodules are usually nontender and occur singly, although satellite nodules may surround the main one. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings may include edema and dimpling (peau d’orange) of the skin overlying the mass, erythema, accentuated veins, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.

Fibrocystic breast disease

The most common cause of breast nodules, this condition produces smooth, round, slightly elastic nodules that increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren’t fixed to underlying breast tissue, they don’t produce retraction signs, such as nipple deviation or dimpling. A clear, watery (serous), or sticky nipple discharge may appear in one or both breasts. Signs and symptoms of premenstrual syndrome—including headache, irritability, bloating, nausea, vomiting, and abdominal cramping—may also be present.

Intraductal papilloma

Intraductal papilloma is a small, benign nodule that grows in the lactiferous ducts. A single larger nodule can sometimes be palpated, but multiple diffuse nodules usually resist palpation. Soft and poorly delineated papillomas usually lie in the subareolar margin. The primary sign of this disorder is a serous or bloody nipple discharge, typically from only one duct. Breast pain and tenderness may also occur.

Mammary duct ectasia

This disorder, which affects menopausal or postmenopausal women, produces a rubbery breast nodule that usually lies under the areola. It’s commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; a thick, sticky, multicolored nipple discharge from multiple ducts; nipple retraction; and a bluish green discoloration or peau d’orange on the skin overlying the mass. Axillary lymphadenopathy may also occur.

Mastitis

In mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d’orange as well as high fever, chills, malaise, and fatigue.

Nipple adenoma

Although similar in symptoms to Paget’s disease, adenomas rarely produce a deep-seated mass.

Paget’s disease

Paget’s disease is a slow-growing intraductal carcinoma that begins as a scaling, eczematoid nipple lesion on one side. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Breast pain [Mastalgia]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Areolar gland abscess

A tender, palpable abscess on the periphery of the areola may result from infection and inflammation of Montgomery’s glands. Fever may also occur.

Breast abscess (acute)

Local pain, tenderness, erythema, peau d’orange, and warmth are associated with a nodule in the affected breast. Malaise, fever, and chills may also occur.

Breast cyst

A breast cyst that enlarges rapidly may cause acute, localized, and usually unilateral pain. A breast nodule may be palpable.

Fat necrosis

Local pain and tenderness may develop in this benign disorder. A history of trauma usually is present. Associated findings include ecchymosis; erythema of the overriding skin; a firm, irregular, fixed mass; and skin retraction signs, such as skin dimpling and nipple retraction. Fat necrosis may be hard to differentiate from breast cancer.

Fibrocystic breast disease

Fibrocystic breast disease is a common cause of breast pain. Initially, the cysts may cause pain only before menstruation. Later in the course of the disorder, pain and tenderness may persist throughout the cycle. The cysts feel firm, mobile, and well defined. Many occur bilaterally in the upper outer quadrant of the breast, but others are unilateral and generalized. A clear, serous nipple discharge may be present in one or both breasts. Signs and symptoms of premenstrual syndrome—including headache, irritability, bloating, nausea, vomiting, and abdominal cramping—may also be present.

Intraductal papilloma

Unilateral breast pain or tenderness may accompany intraductal papilloma, although the primary sign is a serous or bloody nipple discharge, usually from only one duct. Intraductal papilloma is the primary cause of nipple discharge in nonpregnant, nonlactating women. Associated signs include a small (usually 1.5- to 3-mm), soft, poorly delineated mass in the ducts beneath the areola.

Mammary duct ectasia

Burning pain and itching around the areola may occur, although ectasia usually produces no symptoms initially. The history may include one or more episodes of inflammation with pain, tenderness, erythema, and acute fever (or with pain and tenderness alone), which subside spontaneously within 7 to 10 days. Other findings include a rubbery, subareolar breast nodule; areolar swelling and erythema; nipple retraction; a bluish green discoloration or peau d’orange of the skin overlying the nodule; a thick, sticky, multicolored nipple discharge from multiple ducts; and axillary lymphadenopathy. A breast ulcer may occur in late stages.

Mastitis

Unilateral pain may be severe, particularly when the inflammation occurs near the skin surface. Breast skin is typically red and warm at the inflammation site; peau d’orange may be present. Palpation reveals a firm area of induration. Skin retraction signs—such as breast dimpling and nipple deviation, inversion, or flattening—may be present. Systemic signs and symptoms—such as high fever, chills, malaise, and fatigue—may also occur.

Sebaceous cyst (infected)

Breast pain may be reported with this cutaneous cyst. Associated findings include a small, well-delineated nodule; localized erythema; and induration.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Breast Mass/Discharge: Differential Overview
(Field Guide to Bedside Diagnosis)

Breast Mass

❑ Fibrocystic disease

❑ Fibroadenoma

❑ Breast cancer

❑ Intraductal papilloma

❑ Mastitis

❑ Hematoma

❑ Thrombophlebitis

❑ Galactocele

Breast Discharge

❑ Drugs

❑ Postpartum lactation

❑ Prolactin-secreting pituitary adenoma

❑ Intraductal papilloma

❑ Fibrocystic disease

❑ Breast cancer

❑ Mammary duct ectasia

❑ Repeated nipple stimulation

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Breast cancer: Causes
(Handbook of Diseases)

The cause of breast cancer is unknown, but its high incidence in women implicates estrogen. Certain predisposing factors are clear; women at high risk include those who:

❑  have a family history of breast cancer

❑  have long menses; began menses early or menopause late

❑  have never been pregnant

❑  were first pregnant after age 31

❑  have had unilateral breast cancer

❑  have had endometrial or ovarian cancer

❑  have been exposed to low-level ionizing radiation.

Many other predisposing factors have been investigated, including estrogen therapy, antihypertensives, high-fat diet, obesity, and fibrocystic disease of the breasts.

Women at lower risk include those who:

❑  were pregnant before age 20

❑  have had multiple pregnancies

❑  are Indian or Asian.

Pathophysiology

Breast cancer is more common in the left breast than in the right and more common in the upper outer quadrant.  Growth rates vary. Theoretically, slow-growing breast cancer may take up to 8 years to become palpable at 1 cm in size. It spreads by way of the lymphatic system and the bloodstream, through the right side of the heart to the lungs and, eventually, to the other breast, the chest wall, liver, bone, and brain.

Many refer to the estimated growth rate of breast cancer as doubling time, or the time it takes the malignant cells to double in number. Survival time for breast cancer is based on tumor size and spread; the number of involved nodes is the single most important factor in predicting survival time.

Classified by histologic appearance and location of the lesion, breast cancer may be:

❑ adenocarcinoma — arising from the epithelium

❑ intraductal — developing within the ducts (includes Paget’s disease)

❑ infiltrating — occurring in parenchymatous tissue of the breast

❑ inflammatory (rare) — reflecting rapid tumor growth, in which the overlying skin becomes edematous, inflamed, and indurated

❑ lobular carcinoma in situ — reflecting tumor growth involving lobes of glandular tissue

❑ medullary or circumscribed — a large tumor with a rapid growth rate.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Breast nodule: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adenofibroma

The extremely mobile or “slippery” feel of an adenofibroma (a benign neoplasm) helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn’t cause pain or tenderness, can vary from pinhead size to very large, typically grows rapidly, and usually lies around the nipple or on the lateral side of the upper outer quadrant.

Areolar gland abscess

An areolar gland abscess is characterized by a tender, palpable abscess on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever, local swelling, and drainage may also be present, and the patient may complain of malaise.

Breast abscess

A localized, hot, tender, fluctuant mass with erythema and peau d’orange typifies an acute breast abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. With a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It’s commonly accompanied by skin dimpling, peau d’orange, and nipple retraction and sometimes by axillary lymphadenopathy.

Breast cancer

A hard, poorly delineated nodule that’s fixed to the skin or underlying tissue suggests breast cancer. Malignant nodules commonly cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant.

Nodules usually occur singly, although satellite nodules may surround the main one. They’re usually nontender. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings include edema (peau d’orange) of the skin overlying the mass, erythema, tenderness, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.

Fibrocystic breast disease

The most common cause of breast nodules, fibrocystic breast disease produces smooth, round, slightly elastic nodules, which increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren’t fixed to underlying breast tissue, they don’t produce retraction signs, such as nipple deviation or dimpling. A clear, watery (serous), or sticky nipple discharge may appear in one or both breasts. Signs and symptoms of premenstrual syndrome — including headache, irritability, bloating, nausea, vomiting, and abdominal cramping — may also be present.

Intraductal papilloma

The tiny nodules of intraductal papilloma (a benign lesion) usually resist palpation. Nodules large enough to be palpated usually occur singly, but they may be multiple and diffuse. Soft and poorly delineated, the nodules usually lie in the subareolar margin. The primary sign of this disorder is serous or bloody nipple discharge, typically from only one duct. Breast pain and tenderness may occur.

Mammary duct ectasia

The rubbery breast nodule in mammary duct ectasia — a menopausal or postmenopausal disorder — usually lies under the areola. It’s commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; thick, sticky, multicolored nipple discharge from multiple ducts; and nipple retraction. The skin overlying the mass may be bluish green or exhibit peau d’orange. Axillary lymphadenopathy is possible.

Mastitis

With mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d’orange, plus high fever, chills, malaise, and fatigue.

Paget’s disease

In Paget’s disease, the slow-growing intraductal carcinoma begins as a scaling, eczematoid unilateral nipple lesion. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Breast Enlargement: Principal Causes of Breast Enlargement
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

  1. Infectious
    1. Cellulitis/abscess
  2. Noninfectious
    1. Infancy
      1. Physiologic hypertrophy
    2. Childhood
      1. Premature thelarche
      2. Precocious puberty
      3. Gynecomastia (male)
      4. Neoplasm (rare)
    3. Adolescence
      1. Girls
        1. Cysts
        2. Trauma
        3. Macromastia
        4. Juvenile hypertrophy
        5. Fibrocystic disease
        6. Neoplasm
      2. Boys
        1. Physiologic gynecomastia
        2. Drugs
        3. Klinefelter syndrome
        4. Neoplasm
        5. Other

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Breast nodule [Breast lump]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Adenofibroma.The extremely mobile or “slippery” feel of this benign neoplasm helps distinguish it from other breast nodules. The nodule usually occurs singly and characteristically feels firm, elastic, and round or lobular, with well-defined margins. It doesn't cause pain or tenderness, can vary from pinhead size to very large, commonly grows rapidly, and usually lies around the nipple or on the lateral side of the upper outer quadrant.

Areolar gland abscess.Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also be present.

Breast abscess.A localized, hot, tender, fluctuant mass with erythema and peau d'orange typifies an acute abscess. Associated signs and symptoms include fever, chills, malaise, and generalized discomfort. With a chronic abscess, the nodule is nontender, irregular, and firm and may feel like a thick wall of fibrous tissue. It's commonly accompanied by skin dimpling, peau d'orange, nipple retraction and, sometimes, axillary lymphadenopathy.

Breast cancer.A hard, poorly delineated nodule that's fixed to the skin orunderlying tissue suggests breast cancer. Malignant nodules typically cause breast dimpling, nipple deviation or retraction, or flattening of the nipple or breast contour. Between 40% and 50% of malignant nodules occur in the upper outer quadrant.

Nodules usually occur singly, although satellite nodules may surround the main one. They're usually nontender. Nipple discharge may be serous or bloody. (A bloody nipple discharge in the presence of a nodule is a classic sign of breast cancer.) Additional findings include edema (peau d'orange) of the skin overlying the mass, erythema, tenderness, and axillary lymphadenopathy. A breast ulcer may occur as a late sign. Breast pain, an unreliable symptom, may be present.

Fibrocystic breast disease.The most common cause of breast nodules, this fibrocystic condition produces smooth, round, slightly elastic nodules, which increase in size and tenderness just before menstruation. The nodules may occur in fine, granular clusters in both breasts or as widespread, well-defined lumps of varying sizes. A thickening of adjacent tissue may be palpable. Cystic nodules are mobile, which helps differentiate them from malignant ones. Because cystic nodules aren't fixed to underlying breast tissue, they don't produce retraction signs, such as nipple deviation or dimpling. Signs and symptoms of premenstrual syndrome—including headache, irritability, bloating, nausea, vomiting, and abdominal cramping—may also be present.

Mammary duct ectasia.The rubbery breast nodule in mammary duct ectasia, a menopausal or postmenopausal disorder, usually lies under the areola. It's commonly accompanied by transient pain, itching, tenderness, and erythema of the areola; thick, sticky, multicolored nipple discharge from multiple ducts; and nipple retraction. The skin overlying the mass may be bluish green or exhibit peau d'orange. Axillary lymphadenopathy is possible.

Mastitis.With mastitis, breast nodules feel firm and indurated or tender, flocculent, and discrete. Gentle palpation defines the area of maximum purulent accumulation. Skin dimpling and nipple deviation, retraction, or flattening may be present, and the nipple may show a crack or abrasion. Accompanying signs and symptoms include breast warmth, erythema, tenderness, and peau d'orange as well as a high fever, chills, malaise, and fatigue.

Paget's disease.Paget's disease is a slow-growing intraductal carcinoma that begins as a scaling, eczematoid unilateral nipple lesion. The nipple later becomes reddened and excoriated and may eventually be completely destroyed. The process extends along the skin as well as in the ducts, usually progressing to a deep-seated mass.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Breast pain [Mastalgia]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Areolar gland abscess.Areolar gland abscess is a tender, palpable mass on the periphery of the areola following an inflammation of the sebaceous glands of Montgomery. Fever may also occur.

Breast abscess (acute).In the affected breast, local pain, tenderness, erythema, peau d'orange, and warmth are associated with a nodule. Malaise, fever, and chills may also occur.

Breast cyst.A breast cyst that enlarges rapidly may cause acute, localized, and usually unilateral pain. A palpable breast nodule may be present.

Fat necrosis.Local pain and tenderness may develop in fat necrosis, a benign disorder. A history of trauma usually is present. Associated findings include ecchymosis; erythema of the overriding skin; a firm, irregular, fixed mass; and skin retraction signs, such as skin dimpling and nipple retraction. Fat necrosis may be hard to differentiate from cancer.

Fibrocystic breast disease.Fibrocystic breast disease is a common cause of breast pain that's associated with the development of cysts that may cause pain before menstruation and are asymptomatic afterward. Later in the course of the disorder, pain and tenderness may persist throughout the cycle. The cysts feel firm, mobile, and well defined. Many are bilateral and found in the upper outer quadrant of the breast, but others are unilateral and generalized. Signs and symptoms of premenstrual syndrome—including headache, irritability, bloating, nausea, vomiting, and abdominal cramping—may also be present.

Mammary duct ectasia.Burning pain and itching around the areola may occur, although ectasia is commonly asymptomatic at first. The history may include one or more episodes of inflammation with pain, tenderness, erythema, and acute fever, or with pain and tenderness alone, which develop and then subside spontaneously within 7 to 10 days. Other findings include a rubbery, subareolar breast nodule; swelling and erythema around the nipple; nipple retraction; a bluish green discoloration or peau d'orange of the skin overlying the nodule; a thick, sticky, multicolored nipple discharge from multiple ducts; and axillary lymphadenopathy. A breast ulcer may occur in late stages.

Mastitis.Unilateral pain may be severe, particularly when the inflammation occurs near the skin surface. Breast skin is typically red and warm at the inflammation site; peau d'orange may be present. Palpation reveals a firm area of induration. Skin retraction signs—such as breast dimpling and nipple deviation, inversion, or flattening—may be present. Systemic signs and symptoms—such as high fever, chills, malaise, and fatigue—may also occur.

Sebaceous cyst (infected).Breast pain may be reported with sebaceous cyst, a cutaneous cyst. Associated symptoms include a small, well-delineated nodule, localized erythema, and induration.

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Source: Nursing: Interpreting Signs and Symptoms, 2007


 » Next page: Symptoms of Fibrocystic breasts

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