What is the cause of circumferential nipple retraction with or without a mass in a patient (Pt), considering possibilities such as carcinoma (Ca) or duct ectasia (Ductasia)?

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Last updated: April 26, 2025View editorial policy

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Differential Diagnosis for Circumferential Nipple Retraction

  • Single most likely diagnosis
    • A. Cancer (Ca): The most common cause of circumferential nipple retraction is breast cancer, particularly invasive ductal carcinoma. Nipple retraction occurs due to the tumor's contraction and fibrosis, pulling the nipple inward.
  • Other Likely diagnoses
    • B. Ductasia: Duct ectasia or ductasia is a condition where the milk ducts in the breast become widened, leading to inflammation and possible nipple retraction. It's a benign condition but can cause symptoms similar to breast cancer.
    • Periductal mastitis: This is an inflammatory condition that can cause nipple retraction and is often associated with smoking.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Inflammatory breast cancer: Although rare, this aggressive form of breast cancer can cause nipple retraction along with skin changes and should not be missed due to its poor prognosis.
    • Paget's disease of the breast: A rare form of breast cancer that affects the nipple-areola complex, causing nipple retraction, eczema-like changes, and potentially underlying ductal carcinoma.
  • Rare diagnoses
    • Tuberculosis of the breast: A rare condition that can cause nipple retraction among other symptoms like breast masses and discharge.
    • Sarcoidosis: A systemic disease that can rarely affect the breast, causing nipple retraction and other symptoms.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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