Symptom Finder - Breast Mass Or Swelling
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.
A skin or subcutaneous mass is most commonly an abscess, sebaceous cyst, lipoma, or neurofibroma. 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. A course of antibiotics and an I&D may be indicated. If it is not tender, one should suspect a tumor and a referral to a surgeon would be the next logical step. 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
1. CBC (infection)
2. Culture of discharge (breast abscess)
3. Serum prolactin level (pituitary adenoma)
4. CT scan of the brain (pituitary adenoma)
5. MRI
6. Single photon emission computed tomography scan
7. Positron emission tomography scan
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. 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. A course of antibiotics and an I&D may be indicated. If it is not tender, one should suspect a tumor and a referral to a surgeon would be the next logical step. 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
1. CBC (infection)
2. Culture of discharge (breast abscess)
3. Serum prolactin level (pituitary adenoma)
4. CT scan of the brain (pituitary adenoma)
5. MRI
6. Single photon emission computed tomography scan
7. Positron emission tomography scan