Differential Diagnosis for Female with Swelling and Peau d'Orange

Given the symptoms of a 3 cm swelling with peau d'orange and supraclavicular lymph node (L.N) involvement without evidence of distant metastasis, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis:

  • T4b N3c M0: This staging suggests a locally advanced breast cancer with skin changes (peau d'orange, which is a sign of lymphedema of the skin, often associated with T4b) and supraclavicular lymph node involvement (N3c), which indicates a poor prognosis but no distant metastasis (M0).

• Other Likely Diagnoses:

  • T3 N1 M0: This could be considered if the peau d'orange is not as extensive as to classify the tumor as T4b, and the lymph node involvement is less than what would be required for N3c classification. However, the presence of supraclavicular lymph nodes typically points towards a more advanced N stage.
  • T4b N3c M0 variations: Depending on the exact extent of skin involvement and lymph node status, other T4 or N classifications could be considered, but T4b N3c M0 seems the most fitting given the provided details.

• Do Not Miss Diagnoses:

  • Inflammatory Breast Cancer (IBC): Although not explicitly mentioned in the staging options, IBC is a rare but aggressive form of breast cancer that can present with peau d'orange and should be considered in any case of rapid onset of breast swelling and skin changes.
  • Metastatic Disease to the Breast: Although the question specifies no evidence of distant metastasis, it's crucial to consider the possibility of a metastatic tumor to the breast from another primary site, especially if the clinical presentation is atypical for breast cancer.

• Rare Diagnoses:

  • Lymphoma: Both Hodgkin and non-Hodgkin lymphoma can present with lymphadenopathy, including supraclavicular nodes, and less commonly with skin changes resembling peau d'orange.
  • Other Rare Tumors: Such as phyllodes tumors or sarcomas, which can present with a rapid increase in breast size and skin changes, although these would be much less common than breast cancer.

Each of these diagnoses requires careful consideration of the clinical presentation, imaging studies, and pathological findings to determine the most accurate staging and diagnosis.