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Differential Diagnosis for Oncology History

  • Single most likely diagnosis
    • Inflammatory Breast Cancer (IBC): This is the most likely diagnosis due to the rapid progression of the breast lump, ulceration, and non-healing skin changes, along with the involvement of the nipple-areola complex and the presence of matted axillary lymph nodes. The large size of the mass and the skin thickening also support this diagnosis.
  • Other Likely diagnoses
    • Locally Advanced Breast Cancer: The large size of the tumor, skin ulceration, and involvement of axillary lymph nodes suggest a locally advanced breast cancer. However, the absence of systemic symptoms and the specific characteristics of the tumor and skin changes make IBC more likely.
    • Triple-Negative Breast Cancer: Although not explicitly stated, the aggressive nature of the tumor and the lack of information about hormone receptor status or HER2 status could suggest a triple-negative subtype, which is often more aggressive.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Metastatic Disease to the Breast: Although rare, metastasis to the breast from other primary sites (e.g., lung, melanoma, or gastrointestinal cancers) could present similarly and would significantly alter the treatment approach.
    • Lymphoma Involving the Breast: Both Hodgkin and non-Hodgkin lymphoma can involve the breast and axillary lymph nodes, presenting with a rapidly enlarging mass.
    • Angiosarcoma of the Breast: A rare and aggressive malignancy that can present with skin changes and a rapidly growing mass, often with a poor prognosis if not recognized early.
  • Rare diagnoses
    • Phyllodes Tumor: Although typically benign or borderline, malignant phyllodes tumors can grow rapidly and present with large masses, but they are less likely to cause the significant skin changes and lymph node involvement seen in this case.
    • Carcinosarcoma of the Breast: A rare, aggressive tumor containing both carcinoma and sarcoma elements, which could present with a rapidly growing mass and skin changes, but is much less common than other breast cancers.

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