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Differential Diagnosis 1:
Non-Proliferative Breast Lesions: Simple cysts
Left Picture: A Breast Cyst. (2018). photograph. Retrieved from https://www.mayoclinic.org/diseases-conditions/breast-cysts/symptoms-causes/syc-20370284
Right Picture: Halls. (7AD). Simple Breast Cyst. [Photograph]. Retrieved from https://breast-cancer.ca/simplecyst/
- A simple cyst in the breast is a fluid filled sac that appears as a round/oval lump. A simple cyst falls into the category of non-proliferative breast lesion, and it is the most common within this category (McCance, K. L. & Huether, S. E., 2019). Most simple cysts in the breast have defined edges and are considered benign. Simple cysts can range in size and can be found among women of all ages, but are most commonly found among women aged 35-50 years old, right before menopause for many women. Women can develop one or several simple cysts that can be found in either or both breasts. Currently, researchers have yet to determine the exact cause of simple cysts in the breast. One of the many hypotheses for the cause of simple cysts in the breast is excess estrogen, which is known to simulate breast tissue, and could contribute to the formation of simple cysts (Berg, W. A., Sechtin, A. G., Marques, H., & Zhang, Z. , 2010).
- Features from the case that would point to the differential of simple cyst include the patient’s gender, age, a hard, single, painless mass, the patient’s previous pregnancy, the fact that she has a lactation history, and that the patient is on birth control.
- Features of the differential diagnosis of a simple cyst that are not mentioned in the case include a stated elevated caffeine intake and the presence of unilateral nipple discharge.
Differential Diagnosis 2:
Proliferative Breast Lesions without Atypia: Fibroadenoma
Left Picture: Timonina / Shutterstock. (n.d.). Fibroadenoma Breast. [photograph]. Retrieved from https://virajclinic.com/index.php?id_product=82&id_product_attribute=0&rewrite=fibroadenoma-breast&controller=product
Right Picture: Meštrović,, D. T., & Litman / Shutterstock, D. A. (n.d.). Breast Biopsy: Microscopic image (photomicrograph) of a fibroadenoma, a benign circumscribed tumor composed of both glandular and stromal tissue. [photograph]. Retrieved from https://www.news-medical.net/health/What-are-Breast-Fibroadenomas.aspx
- A Fibroadenoma is a benign tumor in the breast. A Fibroadenoma falls into the category of proliferative breast lesions without atypia (McCance, K. L. & Huether, S. E., 2019). Most fibroadenomas are found in varying sizes, which can change overtime, and they have smooth distinct borders, which can be appreciated on imaging. Fibroadenomas often grow during pregnancy or with the use of hormone therapy, while they often shrink during menopause. There are numerous different types of fibroadenomas, such as simple, giant, and complex. Furthermore, fibroadenomas are most commonly found among women aged 15-35 years old, but a women of any age can develop one or several in either or both breasts. Similarly to a simple breast cyst, the cause of fibroadenomas in the breast is undetermined, but many professionals in the field believe there is a correlation with varying levels of hormones throughout different periods of life as mentioned above (Ajmal, M.,2018).
- Features from the case that would point to the differential of Fibroadenoma include the patient’s gender, age, and a hard, single, painless mass.
- A feature of the differential diagnosis of Fibroadenoma that is not included in the case is a change in the size of the mass throughout the menstrual cycle on birth control.
Differential Diagnosis 3:
Inflammation: Lymphocytic Mastopathy
Left and Right Pictures: Mammography – right and left mediolateral oblique views (A) and right and left craniocaudal views (B). Homogeneously dense breasts containing an isodense, ovoid, well delimited nodule measuring about 20 mm in the left retroareolar region, in association with intermingled and adjacent extensive, coalescent and amorphous calcification. (n.d.). [photograph] Retrieved from http://www.scielo.br/scielo.php?pid=S0100-39842014000400013&script=sci_arttext&tlng=en
- Lymphocytic Mastopathy is an inflammatory condition of the breast that leads to the formation of benign breast masses. Lymphocytic Mastopathy falls into the category of benign breast disease and more specifically, inflammatory illness (McCance, K. L. & Huether, S. E., 2019). Lymphocytic mastopathy is also known as diabetic mastopathy and is a rare condition that heavily mimics breast cancer in both the clinical and radiological aspects, including having irregular borders. This inflammatory condition can occur at both early and late onset of diabetes, with a bimodal distribution in the mid 20s and again in the mid 50s. On palpation, these lesions are firm and can be found to be single or multiple, and found in either or both breasts. The hypothesized cause of this inflammatory condition is that there is an autoimmune reaction against matrix in tissues that have been affected by high glucose levels (Alhabshi, S. M., Rahmat, K., Westerhout, C. J., Md Latar, N. H., Chandran, P. A., & Aziz, S., 2013).
- Features from the case that would point to the differential of Lymphocytic Mastopathy include the patient’s gender, age, and a hard, single, painless mass.
- Features from the differential of Lymphocytic Mastopathy that are not included in the case are autoimmune conditions such as type 1 diabetes or autoimmune thyroid disease.