Differential Diagnosis

Breast-related complications are some of the most common problems that women
consult physicians in the United States. The leading problems that these women present during
their visits include nipple discharge, breast pain, and palpable mass (Morrow, 2000) . In this
case, a patient presents to me with a breast mass, which is one of the leading causes and
symptoms of breast cancer. Finding a mass (cyst) in your breast can be frustrating, though most
women are unaware of the fact that not all masses are cancerous. Breast cysts or masses are
broadly categorized into malignant (cancerous) or benign (Morrow, 2000) . The latter category
is commonly caused by fibroadenoma, fibrocystic disease, abscess, and intraductal papilloma
(Morrow, 2000) . Malignant masses, on the other hand, generally include several types of
histologic diseases such as lobular carcinoma, in situ ductal, and inflammatory carcinoma,
among others.
Since many women presenting with breast masses are scared of the likelihood of cancer,
differential diagnosis is essential to their treatment process. The patient is a pre-menopausal
woman. Therefore, her glandular tissue of the breast is nodular, which is pronounced in the
upper outer part of her breast. Her mass is poorly defined but differs from the corresponding
area in the contralateral breast, which worries her so much. She indicates that her cyst fluctuates
with her menstrual cycle.
The first differential would be to perform ultrasonography or aspiration to distinguish if the
breast mass is a cyst or a solid mass. If the aspirated fluid is bloody or if it recurs multiple
times, a surgical biopsy will be required. For cysts, a routine cytologic examination should be
recommended with an aspiration follow after four to six weeks. On the other hand, solid breast
masses require histologic sampling by excisional biopsy. Imaging might be required to

3
determine the malignancy of the solid mass. However, the decision to perform a biopsy is
influenced by the clinical findings and not imaging results.

4

Reference:

Morrow, M. (2000). The Evaluation of Common Breast Problems. American Family Physician,
61(8), 2371.