Differential Diagnosis for Asymmetry in the Subareolar Left Breast
- Single most likely diagnosis
- Fibroadenoma: This is a common benign breast tumor that can present as an asymmetry, especially in younger women. The location and description on the craniocaudal tomosynthesis image could be consistent with a fibroadenoma, although the lack of a definite correlate on the mediolateral oblique view might suggest a need for further evaluation.
- Other Likely diagnoses
- Cyst: A breast cyst is a fluid-filled sac that can cause asymmetry. While cysts are more commonly identified on ultrasound, they can sometimes be seen on mammography, especially if they are large or if there is associated calcification.
- Focal fibrosis: This refers to an area of dense fibrous tissue in the breast, which can cause asymmetry. It's a benign condition but can sometimes mimic more serious conditions on imaging.
- Intraductal papilloma: These are small, benign tumors that grow in the milk ducts of the breast. They can cause a subareolar mass or asymmetry, especially if they become large or numerous.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Breast cancer (especially ductal carcinoma in situ or invasive ductal carcinoma): While less likely than benign causes, breast cancer must always be considered in the differential diagnosis of a new breast asymmetry, especially if it is located close to the nipple. The lack of a clear correlate on the mediolateral oblique view does not rule out malignancy.
- Papillary carcinoma: A rare type of breast cancer that can present as a subareolar mass or asymmetry.
- Rare diagnoses
- Phyllodes tumor: A rare type of breast tumor that can be benign, borderline, or malignant. They are usually larger than fibroadenomas and can cause significant asymmetry.
- Hemangioma: A benign vascular tumor that can occur in the breast and cause asymmetry, although this is very rare.
- Fat necrosis: This can cause a mass or asymmetry in the breast, usually following trauma or surgery. It's less likely to be subareolar but should be considered in the appropriate clinical context.