Differential Diagnosis for Unilateral Tender Breast Mass
Single Most Likely Diagnosis
- Ductectasia: This condition is characterized by the dilation of the milk ducts, often accompanied by inflammation and the formation of small cysts. The symptoms described, such as a unilateral tender breast mass involving and attached to the areola with many small cysts, especially in a breastfeeding woman, align closely with ductectasia. The condition can cause discomfort and is more common in lactating women due to the increased ductal activity.
Other Likely Diagnoses
- Fibrocystic Changes: These are very common in women and can cause lumps, tenderness, and a range of benign breast conditions, including cysts. While fibrocystic changes are more generalized and not typically confined to one area like the areola, they could be considered in the differential due to the presence of small cysts.
- Intraductal Papilloma: Although less likely given the description of multiple small cysts and involvement of the areola, an intraductal papilloma could cause a tender mass if it becomes large enough or if there is associated ductal ectasia. However, papillomas are usually solitary and present with nipple discharge.
Do Not Miss Diagnoses
- Mammary Paget’s Disease: This is a rare form of breast cancer that presents with eczematous changes of the nipple-areolar complex. While the primary complaint here is a tender mass with cysts, any condition involving the areola, especially with unusual symptoms, warrants consideration of Paget’s disease due to its potential for malignancy and the importance of early detection.
- Breast Abscess or Infection: Although not explicitly listed as an option, any tender breast mass, especially in a lactating woman, should prompt consideration of an infectious process like mastitis or a breast abscess, which can present with localized pain, swelling, and sometimes palpable masses.
Rare Diagnoses
- Fibroadenoma: While fibroadenomas are common benign breast tumors, they are less likely in this scenario due to their typical presentation as a well-defined, mobile, and often painless mass, not usually attached to the areola or associated with multiple small cysts.
- Other rare conditions such as syphilitic mastitis or granulomatous mastitis could be considered but are less common and would typically have additional distinguishing features or risk factors.