What diseases are easily confused with breast cancer?
The main diseases that need to be distinguished from breast cancer clinically are
1. Breast hyperplasia: Breast hyperplasia, also known as poor breast structure, is the most common non-inflammatory, non-tumor breast disease in women. Most of them are caused by endocrine dysfunction in women. The age of onset is mostly 20-40 years old, and the incidence is up to 1/3 in developed countries and about 50% in China. The main manifestation is thickening of the breast tissue, and later on, nodules of different sizes can be palpated, with no adhesion to the skin and the back of the breast. They occur in the upper outer quadrant of the breast, mostly bilaterally. Patients have varying degrees of pain, which is obvious before menstruation and can be relieved or relieved after menstruation.
2, breast duct dilatation: this disease is also known as plasmacytoid mastitis, mostly occurs in middle-aged women aged 37-50. The main manifestations are breast pain, nipple overflow and nipple invagination, which is very similar to breast cancer.
The following points can be distinguished from breast cancer.
(1) Patients are younger in age, mostly around 40 years old.
(2) The nipple discharge is mostly plasma or purulent, and a few may be bloody.
(3) Thickened milk ducts can sometimes be palpated under the nipple or areola.
(4) Breast lumps are mostly located around the areola, accompanied by pain, and are closely related to the large ducts.
(5) If there is inflammatory manifestation of the breast or a history of inflammation and breastfeeding disorder, the breast lump may shrink or increase in size.
(6) Ductal dilatation may be demonstrated by mammography.
(7) Nipple discharge with a large number of inflammatory cells.
(8) Large number of inflammatory cells or pus cells may be seen on puncture of the breast lump.
(9) Enlarged axillary lymph nodes with soft texture and pressure pain.
3. Breast tuberculosis: Breast tuberculosis has the following characteristics.
(1) Most of the patients are young and middle-aged women.
(2) Most have a history of tuberculosis or other sites of tuberculosis.
(3) The lesions have a history of inflammation, and the masses are sometimes large and sometimes small, and are effective with anti-tuberculosis drugs.
(4) The masses may have a history of localized redness and rupture, and some cysts are cystic in nature.
(5) The mass is visible by needle aspiration with caseous tissue and thin pus.
(6) There is a history of nipple discharge, which may be purulent.
(7) In a few patients, nipple overflow or pus from needle aspiration is seen on smear with Mycobacterium tuberculosis.
(8) Most of the mammograms are abnormal, and there are those with pale shadows.
(9) There are cases of breast tuberculosis coexisting with breast cancer, accounting for about 5%.
4. Fat necrosis of the breast: The main differential analysis is as follows.
(1) Lack of characteristic clinical manifestations, the lump is usually hard and irregular in shape, resembling breast cancer. Generally, there are 2 clinical types: extraglandular type, superficial, located in the subcutaneous part of the breast, with irregular morphology and inflammatory changes, easily diagnosed as breast tuberculosis; intraglandular type, the mass is located in the parenchyma of the breast, lacking characteristics, easily misdiagnosed as breast cancer.
(2) Lack of effective adjuvant examination, especially in middle-aged and elderly women, the lump is located under the skin, and the lump is not growing or has shrunken, and there is a history of trauma to the breast. Metastatic lymph nodes should be biopsied.
5, acute mastitis: acute mastitis is common in the secretory breast, especially 3-4 weeks after the first birth, the pathogenic bacteria are mostly Staphylococcus aureus and a few for streptococcus, the route of infection is mostly due to retrograde infection at the nipple crack. The infection can also be caused by the direct invasion of bacteria into the milk ducts and upstream to the glandular lobules.
The infection begins with localized redness, swelling, heat, pain, and enlargement of the surrounding lymph nodes, and when necrosis is formed and liquefied, there may be an abscess. The breast is swollen, mobile, hard and painful, and when an abscess is formed, the lump softens and fluctuates. X-rays show dense lamellar shadows with blurred structural boundaries, thickened skin, disorganized subcutaneous fat, more vascular and lymphatic vessels, and vague connective tissue shadows with cords, sometimes with sediment-like calcified lesions.
Comparison of acute mastitis and breast cancer.
(1) There are no orange peel-like changes in the breast skin and no satellite nodules.
(2) Breast lumps rarely occupy the whole breast, and more than half of them have cystic sensation.
(3) Breast masses are less common.
(4) Most of them have increased body temperature and white blood cell count.
(5) Anti-inflammatory treatment is effective.
(6) Needle aspiration is mostly pus or with inflammatory cells, which helps in diagnosis.
(6) Chronic mastitis and abscess: often abscess formation, palpable lump with indistinct margins, cystic feeling, may have light pressure pain, mild adhesion feeling with surrounding tissues. x-ray seen as a local dense lamellar shadow with indistinct borders and slightly thickened skin. Breast abscesses may appear as round or oval irregular dense shadows with clearer edges, with no structure in the central part and lighter density around them due to edema.
The ducts are proliferated and increased by the epithelial cells of breast ducts, resulting in prolongation, tortuosity and folding of the ducts, which can become necrotic and form cysts due to ischemia and later atrophy of the duct walls. Single cysts are in original shape, multiple cysts are oval with smooth and neat cyst wall.
8, cumulative breast cysts: less common. Cysts are formed during lactation due to obstruction of one of the milk ducts. Cysts can be single or multiple, grayish white, containing milk or cheese-like material. X-rays show round or oval translucent areas, small in size, usually 1-37.5px, occasionally >75px, with smooth sharp edges and slightly lower density than fat.
9, breast fibroids: breast fibroids mostly occur in young women aged 20-25 years old and are composed of glands and fibrous tissues, there are two types of youthful type and giant fibroid adenoma type, but there is no qualitative difference. The disease is closely related to estrogen, and there are 2 types: solitary and multiple. The solitary breast fibroids are usually found in the upper outer quadrant of the breast and are mostly small ovoid masses. The surface is smooth, tough, with clear boundaries and no adhesion to the skin and surrounding tissues, and it is easy to push and feel sliding when touched in the breast. The growth is slow and may remain unchanged for several years, but may increase rapidly during pregnancy. Multiple breast fibroids are uniform, moderately hard, and vary in size. Larger ones may be lobulated, smooth, tough and well-defined, with calcified particles in the center of the tumor.
The mammary fibroadenoma has an outer envelope, and the cut surface is grayish white, shiny, not smooth, and the naked eye can see most irregular fissures as dilated milk ducts.
A giant fibroadenoma can be seen on X-ray as a large mass with uniform density and a lobulated shape. The surrounding tissues are pressed to form translucent areas, and there may be calcification in the center of the tumor, which is often accompanied by vascular thickening and varicosities in the vicinity.
Although the tumor is small, it has a higher chance of malignant transformation, so it must be treated carefully.
10.Intraductal papilloma: Intraductal papilloma mostly occurs in women aged 40-50 years old, and 75% of them occur in the large milk duct near the nipple or in the cyst connected with the milk duct near the nipple. They can be solitary or multiple. The tumors are small, but often have villi and more thin-walled blood vessels that bleed easily.
The lump is not usually palpable, but if it is found, it is usually a few millimeters in diameter and located in the areola area. If a lump is found, it is usually a few millimeters in diameter and located in the areola area. Mammary tumors are often round, hard, not adherent to the skin, and can be pushed.
About 6-8% of papillomas in the milk ducts can become cancerous, so angiography should be done before surgery to make a clear diagnosis. The surgery should be thorough, so that the diseased milk duct and its surrounding glandular tissue are removed together to avoid future problems. In older women, simple mastectomy should be performed.