42 female

Left Breast lump- showering yesterday

58 160 lbs, Caucasian.
1) Fibroadenoma: benign solid tumors. women < 30. 7-13% > 25 yo. Median age 47. Simple vs complex
2) Fibrocystic breast changes: group of Nonproliferative changes of stromal/glandular elements of breast tissue that include benign cysts,
diffuse and localized nodularity, nipple discharge, breast tenderness. Women 30-50 yo (less in menopause)
1/800 @ 40 yo
3) Breast carcinoma: risk rises rapidly after 50.
4) Breast abscess- lactating women.
5) Intraductal papilloma- 35-55 yo
6) Fat necrosis- 0.6% prevalence. perimenopausal
7) Mastititis
8) LN enlargement
9) Lipoma 40-60 yo 1%
10) Ruptured implant 8% after 11 yrs of a particular brand
Questions:
- Visual inspection: breast are symmetrical, everted nipples, no lesions or skin changes, no nipple discharge
- Palpation: right breast- doughy, irregular, no dominant concerning lumps. Left: constistency same, but lump in upper outer quad 2 pm 2
cm from areolar edge, tender on palpation. mass 3 cm enlarge, mobile, soft smooth
- LN: axillary, supra/infraclav no adenopathy found
- No personal Hx of cancer. Aunt on dads side had breast cancer at 66 yo.
- Menstrual cycle: 7 days ago was day 1.
- Smoker? No. Nor past smoker
- Elicited nipple discharge: not that she noticed
- OCP: no but 5 year hx of use (Alesse) in her late 20-30s
- Fever? 36.8 C
- No implants
- C cup -> could be less sensitive in testing
- Medication? No
- Drugs? No
- Carried baby to 32 weeks? G1/P1 -> G # of pregnancy. P -> carried to 20/28/32 week. she has delivered a baby when she was 33
(daughter is 9 yo)- she breast fed for 6 months -> decreases chances
- Shes a dental assistant
- Hx of abnormality: lumps in the past. look like this one. Random location
- Menarche: 11 yo (< 11 yo increases Hx of cancer)
- Mammogram: never
- Hereditary markers: no
Conclusion of DDX:
- Fibroadenoma > fibrocystic > breast cancer > lipoma
- US > mamograph in this case
- Biopsy
-