BREAST MASS

Ask the following questions:

1. 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.
2. 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.
3. Does it transilluminate? Cysts of the breasts and galactoceles customarily transilluminate. A mass that does not transilluminate is probably a benign or malignant tumor.
4. 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.
5. 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 Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Breast lump: Introduction (review 62 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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