Breast abscess differential diagnosis

Jump to: navigation, search
Home logo1.png

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2] Shadan Mehraban, M.D.[3]

Overview

Breast abscess should be differentiated from other diseases that cause swelling in the breast skin. These diseases are like mastitis, inflammatory breast cancer, galactocele, plugged duct, mondor's syndrome and fibroadenoma.[1][2] [3][4][5][6][7][8][9][10][11]

Differintiating breast abscess from other diseases

Diseases Laboratory Findings Physical Examination History and Symptoms Other Findings
Culture of the discharge Biopsy Breast tenderness Skin induration Cordlike vein appearance History of trauma Nipple retraction Nipple discharge Erythema Fever Warmth Lymphadenopathy Itching
Breast abscess + - + + - + - + + + + + -
Mastitis + - + - + - + + + + + -
Inflammatory breast cancer - + + + - + - + - + + + *Peau d' orange appearance of the skin

*Metastasis is common.

Galactocele - - - - - - + - - - - - It is differentiated from other masses by US.
Mondor's syndrome + + + - Retracted breast skin and elevation of the skin may be observed.
Cellulitis - + + + - + + -
Fibroadenoma - + - - - - + *Peau d' orange skin apperance.

*Enlarged veins on the skin

Breast abscess must also be differentiated from the following conditions:

Differentiation of breast abscess from different types of breast lumps:

ABBREVIATIONS
LAP=Lymphadenopathy, HRT=Hormonal replacement therapy, FNA=Fine needle aspiration, DCIS=Ductal carcinoma in-situ

Diseases Benign or

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis
Demography History Symptoms Signs Histopathology Imaging
Mass Mastalgia Nipple discharge Breast exam Skin changes LAP
Fibroadenoma[12] + ±
  • Solitary
  • Well-defined
  • Mobile mass
Ultrasound:
  • Well-defined
  • Solid mass
Breast cyst[13]
  • May resolve after aspiration
  • Further evaluation for unresolved masses
+ ±
  • Solitary
  • Cluster of small masses or an ill-defined mass
  • Smooth, firm, and frequently tender
  • Nonproliferative breast lesions
Ultrasound:
  • Simple cyst: Well circumscribed, posterior acoustic enhancement without internal echoes
  • Complicated cyst: Homogenous low-level internal echoes due to without solid components
  • Complex cyst: Thick walls greater than 0.5 mm with solid component
Fibrocystic change[14]
  • Unknown prevalence among adolescents
  • >50% in women of reproductive age
+ + ±
  • Nonproliferative breast lesions
Ultrasound:
  • Small cysts in mammary zone
  • Fibroglandular tissue around the mass
Galactocele[15][16] + ± ± Mammography:
  • Intermediate mass in absence of classic fat-fluid level

Ultrasound:

  • Complex mass
Cysts of montgomery[17]
  • Most common in age of 10-20 years old
  • More than 80% resolve spontaneously
  • Drainage is essential in rare cases
+ ± ±
  • Asymptomatic subareolar mass
  • Drainage of clear to brownish fluid
± Ultrasound:
  • Single cystic lesion in retroareolar area
Hamartoma[18]
  • Common in women older than 35 years old
± ± Mammography:
  • Well-described
  • Discrete, solid, and encapsulated lesion
Breast abscess[19][20]
  • Complication of lactational mastitis in 14% of cases
  • Common among African-American women, heavy smokers , and obese patients
+ + + Ultrasound:
  • Fluid collection
Mastitis[21][22] ± + ± + Breast parenchyma inflammation: Ultrasound:
  • Ill-defined area with hyperechogenicity with inflamed fat lobules
  • Skin thickening
Diseases Benign or
Malignant
Demography History Mass Mastalgia Nipple discharge Breast exam Skin changes LAP Histopathology Imaging Gold standard diagnosis
Breast carcinoma[23][24][25]
  • Most common diagnosed cancer among women
  • Leading cause of cancer death in women 40-49 years old
+ ±
  • Hard
  • Immobile
  • Solitary
  • Irregular margin
± ± Mammography:

Ultrasound:

Ductal carcinoma in situ (DCIS)[26][27] ± ±
  • May have normal physical exam
Mammography:
Microinvasive breast cancer[28]
  • Rare
  • Commonly referred to DCIS with microinvasion
  • Average age 50-60 years old
+ ±
  • Solitary
  • Firm palpable mass
±
  • Associated with high grade DCIS
Mammography:
Breast sarcoma[29]
  • Rare type, < 1% of all breast malignancies
  • Average age of between 45-50 years
+
  • Well-defined
  • Firm mass
± Mammography:
  • Noncalcified oval mass Indistinct margins
Phyllodes tumor[30][31] ±
  • Smooth and multinodular
  • Well-defined
  • Firm mass
  • Mobile
  • Nonepithelial breast neoplasm with average size of 5 cm
Ultrasound:
  • Solid mass
  • Hypoechoic
  • Well-circumscribed

Mammography:

  • Smooth mass
  • Polylobulated mass
Lymphoma[32][33]
  • Extremely rare ( 0.04%-0.5%)
  • Average age 55-60 years
+
  • Well-defined, firm mass
  • Multiple
± Mammography:
Duct ectasia[34]
  • Usually resolve spontaneously
± ± ±
  • Usually asymptomatic
  • Distention of subareolar ducts
Ultrasound:
  • Dilated milk ducts
  • Fluid-filled ducts
Intraductal papilloma[35]
  • Common in women between 35-55 years old
+ ± ±
  • Solitary or multiple lesion
  • Large lump near nipple
  • Growth of papillary cell into a lumen
Ultrasound:
  • Well-defined
  • Solid nodule
Lipoma[36]
  • Common between age of 40-60 years old
  • Benign tumors
  • May experience recurrence
+
  • Solitary
  • Mobile
  • Soft mass
Ultrasound:
  • Well-Circumscribed
  • Hypoechoic lesion
Sclerosing adenosis[37][38]
  • Recurrent pain during mensturation
  • May present as a mass or incidental finding on mammogram
  • No treatment is needed
± +
  • Multiple lesion
  • Firm
  • Tender nodules
±
  • Proliferative disease
Mammography:
Pseudoangiomatous stromal hyperplasia[39][40]
  • Common in reproductive age women
+
  • Solitary firm mass
  • Thickening
Mammography and ultrasound:
  • Well-defined
  • Solid mass
  • Noncalcified
Mondor's disease[41][42]
  • Benign and self-limiting disease
  • Resolve after 4-6 weeks
+ +
  • Thick and tender cord on breast skin
+
  • N/A
Ultrasound:
  • Tubular anechoic structure
  • Multiple narrowing areas
Diseases Benign or
Malignant
Demography History Mass Mastalgia Nipple discharge Breast exam Skin changes LAP Histopathology Imaging Gold standard diagnosis
Diabetic mastopathy[43]
  • Suspicious breast mass
  • After diagnosis, excision is not required
+
  • Ill-defined mass
  • Immobile
Ultrasound:
  • Irregular mass
  • Hypoechoic
  • Dense lesion
Gynecomastia[44][45]
  • Benign breast tissue swelling among men and boys around puberty
+ ± ±
  • Unilateral or bilateral firm mass
  • Breast swelling
  • Rubbery mass
Ultrasound:
Sarcoidosis[46]
  • Rare in patients with systemic involvement
+
  • Firm mass
  • Hard mass
Mammography:
  • Irregular
  • Ill-defined
  • Spiculated solid mass
Fat necrosis[47] + ±
  • Hard or smooth mass
  • Solitary mass
  • Mobile
  • Collections of liquefied fat
Ultrasound:
  • Collections of liquefied fat
  • Oil cysts

References

  1. Greydanus DE, Matytsina L, Gains M (2006). "Breast disorders in children and adolescents". Prim Care. 33 (2): 455–502. doi:10.1016/j.pop.2006.02.002. PMID 16713771.
  2. Jahanfar S, Ng CJ, Teng CL (2013). "Antibiotics for mastitis in breastfeeding women". Cochrane Database Syst Rev (2): CD005458. doi:10.1002/14651858.CD005458.pub3. PMID 23450563.
  3. Lam E, Chan T, Wiseman SM (2014). "Breast abscess: evidence based management recommendations". Expert Rev Anti Infect Ther. 12 (7): 753–62. doi:10.1586/14787210.2014.913982. PMID 24791941.
  4. Kleer CG, van Golen KL, Merajver SD (2000). "Molecular biology of breast cancer metastasis. Inflammatory breast cancer: clinical syndrome and molecular determinants". Breast Cancer Res. 2 (6): 423–9. doi:10.1186/bcr89. PMC 138665. PMID 11250736.
  5. Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA; et al. (2011). "International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment". Ann Oncol. 22 (3): 515–23. doi:10.1093/annonc/mdq345. PMC 3105293. PMID 20603440.
  6. Jaiyesimi IA, Buzdar AU, Hortobagyi G (1992). "Inflammatory breast cancer: a review". J Clin Oncol. 10 (6): 1014–24. doi:10.1200/JCO.1992.10.6.1014. PMID 1588366.
  7. Indelicato DJ, Grobmyer SR, Newlin H, Morris CG, Haigh LS, Copeland EM; et al. (2006). "Delayed breast cellulitis: an evolving complication of breast conservation". Int J Radiat Oncol Biol Phys. 66 (5): 1339–46. doi:10.1016/j.ijrobp.2006.07.1388. PMID 17126205.
  8. Belleflamme M, Penaloza A, Thoma M, Hainaut P, Thys F (2012). "Mondor disease: a case report in ED". Am J Emerg Med. 30 (7): 1325.e1–3. doi:10.1016/j.ajem.2011.06.031. PMID 21855258.
  9. Shetty MK, Watson AB (2001). "Mondor's disease of the breast: sonographic and mammographic findings". AJR Am J Roentgenol. 177 (4): 893–6. doi:10.2214/ajr.177.4.1770893. PMID 11566698.
  10. Kadioglu H, Yildiz S, Ersoy YE, Yücel S, Müslümanoğlu M (2013). "An unusual case caused by a common reason: Mondor's disease by oral contraceptives". Int J Surg Case Rep. 4 (10): 855–7. doi:10.1016/j.ijscr.2013.07.026. PMC 3785854. PMID 23959419.
  11. Boutet G (2012). "Breast inflammation: clinical examination, aetiological pointers". Diagn Interv Imaging. 93 (2): 78–84. doi:10.1016/j.diii.2011.12.001. PMID 22305591.
  12. Pinto, Joana; Aguiar, Ana Teresa; Duarte, Hálio; Vilaverde, Filipa; Rodrigues, Ângelo; Krug, José Luís (2014). "Simple and Complex Fibroadenomas". Journal of Ultrasound in Medicine. 33 (3): 415–419. doi:10.7863/ultra.33.3.415. ISSN 0278-4297.
  13. Courtillot C, Plu-Bureau G, Binart N, Balleyguier C, Sigal-Zafrani B, Goffin V; et al. (2005). "Benign breast diseases". J Mammary Gland Biol Neoplasia. 10 (4): 325–35. doi:10.1007/s10911-006-9006-4. PMID 16900392.
  14. Templeman C, Hertweck SP (2000). "Breast disorders in the pediatric and adolescent patient". Obstet Gynecol Clin North Am. 27 (1): 19–34. PMID 10693180.
  15. Yu JH, Kim MJ, Cho H, Liu HJ, Han SJ, Ahn TG (2013). "Breast diseases during pregnancy and lactation". Obstet Gynecol Sci. 56 (3): 143–59. doi:10.5468/ogs.2013.56.3.143. PMC 3784111. PMID 24327995.
  16. Sabate JM, Clotet M, Torrubia S, Gomez A, Guerrero R, de las Heras P; et al. (2007). "Radiologic evaluation of breast disorders related to pregnancy and lactation". Radiographics. 27 Suppl 1: S101–24. doi:10.1148/rg.27si075505. PMID 18180221.
  17. De Silva NK, Brandt ML (2006). "Disorders of the breast in children and adolescents, Part 2: breast masses". J Pediatr Adolesc Gynecol. 19 (6): 415–8. doi:10.1016/j.jpag.2006.09.002. PMID 17174833.
  18. Tse GM, Law BK, Ma TK, Chan AB, Pang LM, Chu WC; et al. (2002). "Hamartoma of the breast: a clinicopathological review". J Clin Pathol. 55 (12): 951–4. PMC 1769817. PMID 12461066.
  19. D'Alfonso TM, Ginter PS, Shin SJ (2015). "A Review of Inflammatory Processes of the Breast with a Focus on Diagnosis in Core Biopsy Samples". J Pathol Transl Med. 49 (4): 279–87. doi:10.4132/jptm.2015.06.11. PMC 4508565. PMID 26095437.
  20. Dixon JM (2007). "Breast abscess". Br J Hosp Med (Lond). 68 (6): 315–20. doi:10.12968/hmed.2007.68.6.23574. PMID 17639835.
  21. Dixon JM, Ravisekar O, Chetty U, Anderson TJ (1996). "Periductal mastitis and duct ectasia: different conditions with different aetiologies". Br J Surg. 83 (6): 820–2. PMID 8696751.
  22. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists (2007). "ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects". Obstet Gynecol. 109 (2 Pt 1): 479–80. PMID 17267864.
  23. Siegel RL, Miller KD, Jemal A (January 2018). "Cancer statistics, 2018". CA Cancer J Clin. 68 (1): 7–30. doi:10.3322/caac.21442. PMID 29313949.
  24. Li CI, Uribe DJ, Daling JR (October 2005). "Clinical characteristics of different histologic types of breast cancer". Br. J. Cancer. 93 (9): 1046–52. doi:10.1038/sj.bjc.6602787. PMC 2361680. PMID 16175185.
  25. Parise CA, Bauer KR, Brown MM, Caggiano V (2009). "Breast cancer subtypes as defined by the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) among women with invasive breast cancer in California, 1999-2004". Breast J. 15 (6): 593–602. doi:10.1111/j.1524-4741.2009.00822.x. PMID 19764994.
  26. Virnig BA, Tuttle TM, Shamliyan T, Kane RL (February 2010). "Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes". J. Natl. Cancer Inst. 102 (3): 170–8. doi:10.1093/jnci/djp482. PMID 20071685.
  27. Brinton LA, Sherman ME, Carreon JD, Anderson WF (November 2008). "Recent trends in breast cancer among younger women in the United States". J. Natl. Cancer Inst. 100 (22): 1643–8. doi:10.1093/jnci/djn344. PMC 2720764. PMID 19001605.
  28. Sue GR, Lannin DR, Killelea B, Chagpar AB (October 2013). "Predictors of microinvasion and its prognostic role in ductal carcinoma in situ". Am. J. Surg. 206 (4): 478–81. doi:10.1016/j.amjsurg.2013.01.039. PMID 23791403.
  29. Smith TB, Gilcrease MZ, Santiago L, Hunt KK, Yang WT (April 2012). "Imaging features of primary breast sarcoma". AJR Am J Roentgenol. 198 (4): W386–93. doi:10.2214/AJR.11.7341. PMID 22451578.
  30. Geisler DP, Boyle MJ, Malnar KF, McGee JM, Nolen MC, Fortner SM, Broughan TA (April 2000). "Phyllodes tumors of the breast: a review of 32 cases". Am Surg. 66 (4): 360–6. PMID 10776873.
  31. Chaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE, Hunt KK (October 2000). "Primary treatment of cystosarcoma phyllodes of the breast". Cancer. 89 (7): 1502–11. PMID 11013364.
  32. Brogi E, Harris NL (June 1999). "Lymphomas of the breast: pathology and clinical behavior". Semin. Oncol. 26 (3): 357–64. PMID 10375092.
  33. Barişta I, Baltali E, Tekuzman G, Kars A, Ruacan S, Ozişik Y, Güler N, Güllü IH, Atahan IL, Firat D (2000). "Primary breast lymphomas--a retrospective analysis of twelve cases". Acta Oncol. 39 (2): 135–9. PMID 10859001.
  34. Schwartz GF (June 1982). "Benign neoplasms and "inflammations" of the breast". Clin Obstet Gynecol. 25 (2): 373–85. PMID 6286199.
  35. Wen X, Cheng W (January 2013). "Nonmalignant breast papillary lesions at core-needle biopsy: a meta-analysis of underestimation and influencing factors". Ann. Surg. Oncol. 20 (1): 94–101. doi:10.1245/s10434-012-2590-1. PMID 22878621.
  36. Guray M, Sahin AA (May 2006). "Benign breast diseases: classification, diagnosis, and management". Oncologist. 11 (5): 435–49. doi:10.1634/theoncologist.11-5-435. PMID 16720843.
  37. Jensen RA, Page DL, Dupont WD, Rogers LW (1989). "Invasive breast cancer risk in women with sclerosing adenosis". Cancer. 64 (10): 1977–83. PMID 2804888.
  38. Wang J, Costantino JP, Tan-Chiu E, Wickerham DL, Paik S, Wolmark N (2004). "Lower-category benign breast disease and the risk of invasive breast cancer". J Natl Cancer Inst. 96 (8): 616–20. PMID 15100339.
  39. Celliers L, Wong DD, Bourke A (2010). "Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features". Clin Radiol. 65 (2): 145–9. doi:10.1016/j.crad.2009.10.003. PMID 20103437.
  40. Salvador R, Lirola JL, Domínguez R, López M, Risueño N (2004). "Pseudo-angiomatous stromal hyperplasia presenting as a breast mass: imaging findings in three patients". Breast. 13 (5): 431–5. doi:10.1016/j.breast.2003.10.011. PMID 15454202.
  41. Becker L, McCurdy LI, Taves DH (2001). "Superficial thrombophlebitis of the breast (Mondor's disease)". Can Assoc Radiol J. 52 (3): 193–5. PMID 11436415.
  42. Catania S, Zurrida S, Veronesi P, Galimberti V, Bono A, Pluchinotta A (1992). "Mondor's disease and breast cancer". Cancer. 69 (9): 2267–70. PMID 1562972.
  43. Kudva YC, Reynolds C, O'Brien T, Powell C, Oberg AL, Crotty TB (2002). ""Diabetic mastopathy," or sclerosing lymphocytic lobulitis, is strongly associated with type 1 diabetes". Diabetes Care. 25 (1): 121–6. PMID 11772912.
  44. Draghi F, Tarantino CC, Madonia L, Ferrozzi G (2011). "Ultrasonography of the male breast". J Ultrasound. 14 (3): 122–9. doi:10.1016/j.jus.2011.06.004. PMC 3558246. PMID 23397020.
  45. Braunstein GD (2007). "Clinical practice. Gynecomastia". N Engl J Med. 357 (12): 1229–37. doi:10.1056/NEJMcp070677. PMID 17881754.
  46. Lower EE, Hawkins HH, Baughman RP (2001). "Breast disease in sarcoidosis". Sarcoidosis Vasc Diffuse Lung Dis. 18 (3): 301–6. PMID 11587103.
  47. Soo MS, Kornguth PJ, Hertzberg BS (1998). "Fat necrosis in the breast: sonographic features". Radiology. 206 (1): 261–9. doi:10.1148/radiology.206.1.9423681. PMID 9423681.


Linked-in.jpg