BREAST MASS OR SWELLING

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.

BREAST MASS

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 469). 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 mastititis, obstructed and inflamed on a chronic basis in cystic mastitis, 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 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 suspicious mass should be biopsied even if mammography findings are negative.

Other Useful Tests

1. CBC (infection)
2. Culture of discharge (breast abscess)
3. Serum prolactin level (pituitary adenoma)
4. CT scan of the brain (pituitary adenoma)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Swelling symptoms

Read excerpts from these other book chapters related to Swelling symptoms:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Swelling symptoms

• Back to symptom: Swelling symptoms: Introduction (review 3250 causes)
• Next Book Extract About Swelling symptoms: JAW SWELLING (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Swelling symptoms

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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