Differential Diagnosis for a 54-year-old Female with a Red, Painful Area on the Nipple
- Single most likely diagnosis:
- Periductal mastitis: This condition is characterized by inflammation of the ducts under the nipple, often presenting with a painful, red area on the nipple and areola. The patient's history of extensive biopsies for atypical ductal hyperplasia (ADH) and non-papilloma conditions increases the risk for periductal mastitis due to potential ductal damage.
- Other Likely diagnoses:
- Eczema (dermatitis) of the nipple: Eczema can cause redness, itching, and sensitivity, which aligns with the patient's symptoms. Given the location and the fact that it's painful to touch, it's a plausible diagnosis.
- Nipple adenoma or intraductal papilloma: Although the patient has a history of non-papilloma conditions, the possibility of a new lesion, especially given the symptoms of pain and sensitivity, cannot be ruled out without further investigation.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Inflammatory breast cancer (IBC): This aggressive form of breast cancer presents with rapid onset of inflammation, including redness, swelling, and warmth of the breast skin. It's crucial to rule out IBC due to its poor prognosis if not promptly treated.
- Paget's disease of the breast: A rare form of breast cancer that begins in the ducts and spreads to the skin of the nipple and then to the areola. It can cause eczema-like changes, redness, and sensitivity, making it a critical diagnosis not to miss.
- Rare diagnoses:
- Zuska-Atkinson syndrome: A rare condition characterized by recurrent subareolar abscesses, which could potentially present with similar symptoms of pain and redness around the nipple and areola.
- Nipple or areolar basal cell carcinoma or squamous cell carcinoma: Although rare, skin cancers can occur on the nipple and areola, presenting with lesions or areas of redness and sensitivity.