Urogenital | Reference | Breast Lumps

Ref: Breast Lumps

Add a vertical flowchartlike this:
Tender
 |
Y--Inflammation
 |
N--Sharply demarcated
       |
      Y--Fibroadenoma
       |
      N--Carcinoma

Carcinoma
  • Most commonly hardirregular. 
  • Occurs most often in upperouter quadrant.
  • 2nd most common malignancy of women.
  • Most common mass is postmenopausal.
  • Either in situor invasive.
  • Invasive carcinoma subtypes: "The Cancer Most LadiesDread":
    • Tubular
    • Colloid [mucinous]: softwell circumscribed.
    • Medullary
    • Lobular
    • Ductal 
Fibroadenoma
  • Most common tumor [not just a mass] in >25yo.
  • Fibroadenoma is FirmFree (mobile)Flexible(rubbery)Fiercely demarcated ("marble").
  • Occurs most often in upperouter quadrant.
Fibrocystic change
  • Most common palpable mass in 25-50yo.
  • Well named: Fibrosiscystschanges to epithelium.
  • Cysts usually multiplebilateral.
  • Some solitary cysts can be large.
  • Multi-cyst areas have diffuse nodularitiesand consistency increase.
  • Some epithelial changes go on to sclerosing adenosis.
Inflammatory
  • Most tenderness is inflammatory.
  • DDx: abscessmastitis (if started breast feedingbacteria may haveentered cracks)granulomas (sarcoidosisWegener's).
Fat necrosis
  • Subtype of inflammatorysince inflammation follows necrosis.
  • Usually Hx of traumasurgeryor radiation Rx.
  • Single breast.
  • Isolatedsharply localized.
Paget's dz of breast
  • 50% have a palpable mass.
  • Nipple eczemainflammationbleeding.
Chest wall sarcomas
  • Breast area can have sarcomas found elsewhere in chest.
  • Examples: liposacromachondrosarcomaleiomyosarcomaosteosarcoma.
Hyperplasia
Male gynecomastia
  • Under areolacan palpate disc of tissue not found in obese men.
Tietze's disease
  • Swellingdiscomfort of costochondralcostosternal joints.
  • Painful on palpationmay be perceived as breast pain.

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