Mastitis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2] Shadan Mehraban, M.D.[3]
Overview
Mastitis must be differentiated from other diseases that cause breast pain and/or swelling, such as galactocele[1][2], breast engorgement[3][4] [5], mastodynia[6][7][8], fibrocystic breast disease, breast cancer, fibroadenoma, mondor's disease[9][10] and breast abscess.
Differentiating Mastitis from other diseases
Mastitis must be differentiated from other diseases that cause breast pain and swelling as shown below:[11][12] [13][14][15][16][17][10][18][19]
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 |
Other differential diagnosis of mastitis may include:
- Cystosarcoma phyllodes
- Breast cyst
- Breast carcinoma
- Lymphangioma
- Furuncle
- Impetigo
- Neonatal breast hypertrophy
- Breasst engorgement
- Lipoma
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[20] |
|
+ | ± | – |
|
– | – | Ultrasound:
|
|||||
Breast cyst[21] |
|
|
|
+ | ± | – |
|
– | – |
|
Ultrasound: | ||
Fibrocystic change[22] |
|
|
|
+ | + | ± | – | – |
|
Ultrasound: |
| ||
Galactocele[23][24] |
|
|
+ | ± | ± |
|
– | – |
|
Mammography:
|
|||
Cysts of montgomery[25] |
|
|
|
+ | ± | ± |
|
± | – |
|
Ultrasound:
|
||
Hamartoma[26] |
|
|
|
± | – | – |
|
± | – |
|
Mammography:
|
||
Breast abscess[27][28] |
|
|
+ | + | – |
|
+ | – |
|
Ultrasound:
|
|||
Mastitis[29][30] |
|
|
|
± | + | ± |
|
+ | – | Breast parenchyma inflammation: | Ultrasound:
|
||
Diseases | Benign or Malignant |
Demography | History | Mass | Mastalgia | Nipple discharge | Breast exam | Skin changes | LAP | Histopathology | Imaging | Gold standard diagnosis | |
Breast carcinoma[31][32][33] |
|
|
+ | – | ± |
|
± | ± | Mammography:
|
||||
Ductal carcinoma in situ (DCIS)[34][35] |
|
|
± | – | ± |
|
– | – |
|
Mammography:
|
|||
Microinvasive breast cancer[36] |
|
|
+ | – | ± |
|
– | ± |
|
Mammography:
|
|||
Breast sarcoma[37] |
|
|
+ | – | – |
|
± | – |
|
Mammography:
|
|||
Phyllodes tumor[38][39] |
|
|
± | – | – |
|
– | – |
|
Ultrasound:
|
|||
Lymphoma[40][41] |
|
|
+ | – | – |
|
– | ± |
|
Mammography:
|
| ||
Duct ectasia[42] |
|
|
± | ± | ± |
|
– | – |
|
Ultrasound:
|
|||
Intraductal papilloma[43] |
|
+ | ± | ± |
|
– | – |
|
Ultrasound:
|
| |||
Lipoma[44] |
|
|
+ | – | – |
|
– | – |
|
Ultrasound:
|
|||
Sclerosing adenosis[45][46] |
|
|
|
± | + | – |
|
± | – |
|
Mammography:
|
||
Pseudoangiomatous stromal hyperplasia[47][48] |
|
|
+ | – | – |
|
– | – |
|
Mammography and ultrasound:
|
|||
Mondor's disease[49][50] |
|
+ | + | – |
|
+ | – |
|
Ultrasound:
|
| |||
Diseases | Benign or Malignant |
Demography | History | Mass | Mastalgia | Nipple discharge | Breast exam | Skin changes | LAP | Histopathology | Imaging | Gold standard diagnosis | |
Diabetic mastopathy[51] |
|
|
+ | – | – |
|
– | – |
|
Ultrasound:
|
| ||
Gynecomastia[52][53] |
|
|
+ | ± | ± |
|
– | – |
|
Ultrasound: | |||
Sarcoidosis[54] |
|
|
+ | – | – |
|
– | – |
|
Mammography:
|
|||
Fat necrosis[55] |
|
+ | ± | – |
|
– | – |
|
Ultrasound:
|
References
- ↑ Langer A, Mohallem M, Berment H, Ferreira F, Gog A, Khalifa D; et al. (2015). "Breast lumps in pregnant women". Diagn Interv Imaging. 96 (10): 1077–87. doi:10.1016/j.diii.2015.07.005. PMID 26341843.
- ↑ Canlorbe G, Bendifallah S (2015). "[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]". J Gynecol Obstet Biol Reprod (Paris). 44 (10): 1030–48. doi:10.1016/j.jgyn.2015.09.034. PMID 26530177.
- ↑ Pustotina O (2016). "Management of mastitis and breast engorgement in breastfeeding women". J Matern Fetal Neonatal Med. 29 (19): 3121–5. doi:10.3109/14767058.2015.1114092. PMID 26513602.
- ↑ Leung SS (2016). "Breast pain in lactating mothers". Hong Kong Med J. doi:10.12809/hkmj154762. PMID 27313273.
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- ↑ van Bogaert LJ (1986). "[Mastodynia and fibrocystic disease of the breast. Perspectives and methods of medical treatment]". J Gynecol Obstet Biol Reprod (Paris). 15 (6): 805–11. PMID 3794218.
- ↑ Songtish D, Akranurakkul P (2015). "Mastalgia: Characteristics and Associated Factors in Thai Women". J Med Assoc Thai. 98 Suppl 9: S9–15. PMID 26817204.
- ↑ Sen M, Kilic MO, Cemeroglu O, Icen D (2015). "Can mastalgia be another somatic symptom in fibromyalgia syndrome?". Clinics (Sao Paulo). 70 (11): 733–7. doi:10.6061/clinics/2015(11)03. PMC 4642489. PMID 26602519.
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- ↑ 10.0 10.1 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.
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- ↑ 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.
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- ↑ 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.
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- ↑ 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.
- ↑ 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.
- ↑ Dixon JM (2007). "Breast abscess". Br J Hosp Med (Lond). 68 (6): 315–20. doi:10.12968/hmed.2007.68.6.23574. PMID 17639835.
- ↑ 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.
- ↑ 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.
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- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Brogi E, Harris NL (June 1999). "Lymphomas of the breast: pathology and clinical behavior". Semin. Oncol. 26 (3): 357–64. PMID 10375092.
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- ↑ Schwartz GF (June 1982). "Benign neoplasms and "inflammations" of the breast". Clin Obstet Gynecol. 25 (2): 373–85. PMID 6286199.
- ↑ 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.
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- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Braunstein GD (2007). "Clinical practice. Gynecomastia". N Engl J Med. 357 (12): 1229–37. doi:10.1056/NEJMcp070677. PMID 17881754.
- ↑ Lower EE, Hawkins HH, Baughman RP (2001). "Breast disease in sarcoidosis". Sarcoidosis Vasc Diffuse Lung Dis. 18 (3): 301–6. PMID 11587103.
- ↑ 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.