Differentials
Common
Fibroadenoma
History
asymptomatic, found incidentally, typical patient <40 years old
Exam
smooth, rubbery, mobile mass
1st investigation
- mammogram:
oval or round, circumscribed, may have coarse calcifications
- breast ultrasound:
solid, oval or round, circumscribed, lobulated, width greater than height
Other investigations
- breast biopsy:
epithelial and stromal elements
Fibrocystic breast
History
breast pain; commonly found in pre- and perimenopausal women; symptoms fluctuate with menstrual cycles
Exam
rubbery, well-circumscribed, mobile mass
1st investigation
- breast ultrasound:
simple cysts: well-circumscribed with sharp borders, no internal echoes; complex cysts: cystic and solid components
Other investigations
- mammography:
cannot distinguish between cystic and solid masses
- breast aspiration:
resolution of cysts after aspiration suggests a benign cyst
Fat necrosis
Intraductal papilloma
History
bloody nipple discharge
Exam
mass usually small, not always palpable
1st investigation
- mammogram:
may be negative
- breast ultrasound:
dilated duct with oval mass
- breast ductogram:
filling defect of duct
Other investigations
- breast biopsy:
papillary growth pattern: benign papilloma, or atypia, papillary ductal carcinoma in situ, or invasive papillary carcinoma
Breast abscess
History
breast pain, fever; alarming, rapid enlargement
Exam
breast fluctuance, tenderness, and skin erythema; associated mastitis
1st investigation
- breast ultrasound:
fluid-filled cavity containing debris
Other investigations
- breast aspiration:
purulent fluid
Invasive breast cancer
History
gradual breast enlargement noted, personal or family history of breast cancer
Exam
hard, fixed mass; nipple inversion, nipple discharge, skin retraction, peau d'orange, lymphadenopathy
1st investigation
- mammogram:
indistinct or spiculated margins, increased density, fine pleomorphic calcifications
- breast ultrasound:
irregular shape, ill-defined margins, height greater than width, punctate calcifications, hypoechogenicity
More
Other investigations
- breast biopsy:
cells with hyperchromatic nuclei invading into stroma
Ductal carcinoma in situ (DCIS)
History
usually asymptomatic
Exam
breast mass may or may not be present; nipple discharge, breast tenderness, cracking of skin (Paget disease of breast)
1st investigation
- mammography:
often associated with microcalcifications
Other investigations
- breast biopsy:
malignant cells involving ducts that do not cross the basement membrane
Uncommon
Phyllodes tumor
History
40 to 60 years old; recent onset and rapid enlargement of breast
Exam
well-delineated, large breast mass
1st investigation
- mammography:
oval, circumscribed mass
- breast ultrasound:
hypoechoic, well-circumscribed mass
- breast biopsy:
stromal and epithelial elements; histologic classification can vary from benign to malignant
More
Other investigations
Adenoma
History
painless, slowly enlarging breast mass
Exam
well-circumscribed, mobile mass
1st investigation
- mammography:
round or oval lesion with circumscribed margins
Other investigations
- breast ultrasound:
solid, well-circumscribed mass
- breast biopsy:
tubular adenoma
Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH)
History
usually found incidentally
Exam
rarely presents as palpable mass
1st investigation
- mammogram:
no specific findings
- ultrasound:
no specific findings
- breast biopsy:
atypical cells
More
Other investigations
Radial scar
History
usually found incidentally
Exam
rarely presents as palpable mass
1st investigation
- mammogram:
no specific findings
- ultrasound:
no specific findings
- breast biopsy:
atypical cells
Other investigations
Lobular carcinoma in situ (LCIS)
History
usually found incidentally on breast biopsy for another purpose
Exam
rarely presents as a palpable mass
1st investigation
- mammogram:
no specific findings
- breast ultrasound:
no specific findings
- breast biopsy:
malignant cells within lobular acini, basement membrane intact
More
Other investigations
Use of this content is subject to our disclaimer