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: [1][2][3][4][5][6][7]

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[8]
  • 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[9]
  • Hormonal fluctuation
+
  • No increased risk of malignancy for simple cyst
  • <1% for complicated cyst
  • <1% to 23% for complex cyst
    • Cmmon masses found in premenopausal, perimenopausal, and postmenopausal women
    • Mostly seen among HRT users
  • May resolve after aspiration
  • Further evaluation for not completely resolved masses
+ ±
  • 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[10]
  • Unknown
  • Imbalance between estrogen and progestrone
+
  • No increasd risk of malignancy
  • Slightly increased risk of malignancy in prescence of positive familial history of breast cancer
  • Unknown prevalence among adolescents
  • >50% in women of reproductive age
  • Become present before menses and improve during mesturation
+ + ±
  • Painful breast tissue
  • Tender, nodular swelling
NA Nl Nonproliferative breast lesions
  • Small cysts in mammary zone
  • Fibroglandular tissue around the mass
  • Ultrasound
  • Mammography is not recommended for adolescents
NA
Galactocele[11] Milk duct obstruction + No increased risk of malignancy
  • Milk retention cysts with fluid collection among pregnant women and during breast-feeding
  • After ending lactation, the cysts resolve
+ ± ±
  • Soft masses
  • Cystic masses
NA Nl Nonproliferative breast lesions
  • Mammography: Intermediate mass in absence of classic fat-fluid level
  • Ultrasound: Complex mass
  • Ultrasound
  • Mammography
NA
Cysts of montgomery[12] Obstruction of periareolar glands of montgomery + No increased risk of malignancy Most common in age of 10-20 years old
  • More than 80% resolve spontaneously
  • Drainage is essential in rare cases
+ ± ±
  • Asymptomatic subareolar mass
  • Drainage of clear to brownish fluid
± NA Nl Nonproliferative breast lesions Single cystic lesion in retroareolar area Ultrasound NA
Hamartoma +
Breast abscess[13] Complication of breast mastitis + No increased risk of malignancy
  • Complication of lactational mastitis in 14% of cases
  • Common among African American women, heavy smokers , and obese patients
  • Drainage
  • Anti-biotic therapy
+ +
  • Localized inflammation of breast
  • Tenderness
+
  • Fever
  • Malaise
Blood culture is required in severe infection Nonproliferative breast lesions Fluid collection Ultrasound NA
Mastitis[14]
  • Inflammation
  • Infection
+ No increased risk of malignancy
  • Common among lactating women (first three months of breast feeding)
  • Periductal mastitis among smokers and associated with squamous metaplasia
  • Anti-biotic therapy
  • Drainage
± + ± Breast tenderness

Swollen breast tissue

+
  • Fever
  • Nipple retraction
Leukocytosis Nonproliferative breast lesions
  • Ill-defined area with hyperechogenicity with inflamed fat lobules
  • Skin thickening
Ultrasound NA
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 +
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 +
Gynecomastia +
Premenstrual syndrome +
Breast trauma +
Fat necrosis
  • Breast trauma
  • Surgical intervention
+ No increased risk of malignancy + Ultrasound NA

References

  1. Cheung KL, Lam TP (2005). "Approach to a lump in the breast: a regional perspective". Asian J Surg. 28 (1): 65–70. doi:10.1016/S1015-9584(09)60264-5. PMID 15691804.
  2. Collyar DE (2001). "Breast cancer: a global perspective". J Clin Oncol. 19 (18 Suppl): 101S–105S. PMID 11560983.
  3. Lang AP, Luchsinger IS, Rawling EG (1987). "Filariasis of the breast". Arch Pathol Lab Med. 111 (8): 757–9. PMID 3307689.
  4. Varghese R, Raghuveer CV, Pai MR, Bansal R (1996). "Microfilariae in cytologic smears: a report of six cases". Acta Cytol. 40 (2): 299–301. doi:10.1159/000333755. PMID 8629415.
  5. Alagaratnam, T.T. & Wong, J. World J. Surg. (1989) 13: 743. https://doi.org/10.1007/BF01658425
  6. Shukla HS, Kumar S (1989). "Benign breast disorders in nonwestern populations: Part II--Benign breast disorders in India". World J Surg. 13 (6): 746–9. PMID 2623884.
  7. Leung TN, Haines CJ, Chung TK (2001). "Five-year compliance with hormone replacement therapy in postmenopausal Chinese women in Hong Kong". Maturitas. 39 (3): 195–201. PMID 11574178.
  8. Pinto, Joana; Aguiar, Ana Teresa; Duarte, Hálio; Vilaverde, Filipa; Rodrigues, Ângelo; Krug, José Luís (2014). "Simple and Complex Fibroadenomas". Journal of Ultrasound in Medicine. 33 (3): 415–419. doi:10.7863/ultra.33.3.415. ISSN 0278-4297.
  9. Courtillot C, Plu-Bureau G, Binart N, Balleyguier C, Sigal-Zafrani B, Goffin V; et al. (2005). "Benign breast diseases". J Mammary Gland Biol Neoplasia. 10 (4): 325–35. doi:10.1007/s10911-006-9006-4. PMID 16900392.
  10. Templeman C, Hertweck SP (2000). "Breast disorders in the pediatric and adolescent patient". Obstet Gynecol Clin North Am. 27 (1): 19–34. PMID 10693180.
  11. Sabate JM, Clotet M, Torrubia S, Gomez A, Guerrero R, de las Heras P; et al. (2007). "Radiologic evaluation of breast disorders related to pregnancy and lactation". Radiographics. 27 Suppl 1: S101–24. doi:10.1148/rg.27si075505. PMID 18180221.
  12. De Silva NK, Brandt ML (2006). "Disorders of the breast in children and adolescents, Part 2: breast masses". J Pediatr Adolesc Gynecol. 19 (6): 415–8. doi:10.1016/j.jpag.2006.09.002. PMID 17174833.
  13. Dixon JM (2007). "Breast abscess". Br J Hosp Med (Lond). 68 (6): 315–20. doi:10.12968/hmed.2007.68.6.23574. PMID 17639835.
  14. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists (2007). "ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects". Obstet Gynecol. 109 (2 Pt 1): 479–80. PMID 17267864.


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