Differential Diagnosis for Bloody Nipple Discharge
- Single most likely diagnosis
- Intraductal Papilloma: This is the most likely diagnosis given the presentation of bloody discharge from a single duct, which is a classic symptom of intraductal papilloma. The presence of a firm, ill-defined mass in the lower outer quadrant of the right breast with overlying skin retraction also supports this diagnosis, as intraductal papillomas can sometimes be associated with a palpable mass.
- Other Likely diagnoses
- Ductal Carcinoma In Situ (DCIS): DCIS can present with bloody nipple discharge, especially if it involves the ducts close to the nipple. The presence of a mass and skin retraction increases the suspicion for DCIS or invasive cancer.
- Invasive Ductal Carcinoma: Similar to DCIS, invasive ductal carcinoma can cause bloody nipple discharge, a palpable mass, and skin changes, making it a likely consideration in this patient.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Inflammatory Breast Cancer: Although less common, inflammatory breast cancer can present with skin changes, including retraction, and can be associated with nipple discharge. It is a highly aggressive form of breast cancer, making early diagnosis critical.
- Paget's Disease of the Breast: This rare form of breast cancer involves the skin of the nipple and areola and can cause nipple discharge, although it more commonly presents with eczematous changes to the nipple-areolar complex.
- Rare diagnoses
- Breast Abscess or Infection: Although the patient does not have symptoms of infection such as pain, swelling, or fever, a breast abscess could potentially cause bloody discharge, especially if it involves the ducts.
- Galactocele: A galactocele is a milk-filled cyst that can occur in lactating women but is less likely given that the patient stopped breastfeeding 3 months ago. However, it could potentially cause a mass and, if infected, might lead to bloody discharge.
- Fat Necrosis: This condition can mimic cancer both clinically and radiologically, presenting as a firm mass, but it is usually associated with a history of trauma, which this patient does not have.