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 cancer (T4b indicates skin changes such as peau d'orange or ulceration, and N3c indicates supraclavicular lymph node metastasis) without distant metastasis (M0). The presence of peau d'orange and supraclavicular lymph node involvement strongly supports this diagnosis, particularly in the context of breast cancer, where these signs are indicative of advanced disease.

• Other Likely Diagnoses:

  • T3 N1 M0: This could be considered if the swelling and peau d'orange are interpreted as T3 (tumor more than 5 cm) and there's involvement of movable ipsilateral level I, II axillary lymph nodes (N1), but the supraclavicular lymph node involvement typically categorizes the disease as more advanced.
  • T4b N0 M0: Although less likely due to the mention of supraclavicular lymph node involvement, if this were overlooked or misinterpreted, a T4b classification for the skin changes without lymph node involvement could be considered.

• Do Not Miss Diagnoses:

  • Metastatic Disease (e.g., M1): Although the question specifies no evidence of distant metastasis, it's crucial to thoroughly investigate for any signs of metastatic disease, as the presence of supraclavicular lymph node involvement can sometimes be associated with a higher risk of distant spread.
  • Inflammatory Breast Cancer: This aggressive form of breast cancer can present with skin changes similar to peau d'orange and should be considered, especially if there's rapid progression or other signs of inflammation.

• Rare Diagnoses:

  • Other Malignancies: Rarely, other types of cancer (e.g., lymphoma, metastasis from another primary site) could present with similar symptoms, including skin changes and lymphadenopathy. However, these would be less common and typically require additional diagnostic evidence.
  • Non-malignant Conditions: Certain benign conditions could mimic some of these symptoms, such as infectious or inflammatory processes, but these would not typically present with the combination of peau d'orange, a discrete swelling, and supraclavicular lymphadenopathy.