BREAST MASS
BREAST MASS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the following questions:
- Is the mass tender? A tender mass is most likely due to an infectious process such as mastitis or an abscess. However, chronic cystic mastitis may present with a tender mass. Also, advanced carcinoma of the breast usually produces a tender mass.
- Is there a discharge? A bloody discharge from the breast means that the mass is most likely due to a malignant process. If there is a purulent discharge, abscess or mastitis must be considered. A watery discharge is often associated with chronic cystic mastitis, and this occasionally may become bloody.
- Does it transilluminate? Cysts of the breasts and galactoceles customarily transilluminate. A mass that does not transilluminate is probably a benign or malignant tumor.
- Is there a deformity of the breast associated with the mass? An orange peel appearance of the skin over a tumor certainly suggests that it is a carcinoma. Retraction of the skin or the nipple suggests carcinoma. Also, in carcinoma there may be necrosis and ulceration of the tissues overlying the tumor.
- Is there fever? Fever would suggest an acute mastitis or abscess.
DIAGNOSTIC WORKUP
A breast mass is a clear indication for a referral to a general surgeon. The general surgeon will probably perform mammography and a biopsy before proceeding with surgery. If a cystic lesion is suspected, ultrasonography may be done, followed by fine-needle aspiration and biopsy. When there is a definite mass on physical examination, surgery is indicated even if mammography and other tests are negative.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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