Ref: Breast Lumps

• Carcinoma
• Fibroadenoma
• Fibrocystic change
• Inflammatory, fat necrosis
• Other CAs: Paget's, chest wall sarcomas, lymphomas, metastatic, adenoma of nipple, phyllodes, intraductal papilloma 
• Others: hyperplasia, hematoma, male gynecomastia, Tietze's

Add a vertical flowchart, like this:
Tender
 |
Y--Inflammation
 |
N--Sharply demarcated
       |
      Y--Fibroadenoma
       |
      N--Carcinoma

Carcinoma

• Most commonly hard, irregular. 
• Occurs most often in upper, outer quadrant.
• 2nd most common malignancy of women.
• Most common mass is postmenopausal.
• Either in situ, or invasive.
• Invasive carcinoma subtypes: "The Cancer Most Ladies Dread":
  • Tubular
  • Colloid [mucinous]: soft, well circumscribed.
  • Medullary
  • Lobular
  • Ductal 

Fibroadenoma

• Most common tumor [not just a mass] in >25yo.
• Fibroadenoma is Firm, Free (mobile), Flexible (rubbery), Fiercely demarcated ("marble").
• Occurs most often in upper, outer quadrant.

Fibrocystic change

• Most common palpable mass in 25-50yo.
• Well named: Fibrosis, cysts, changes to epithelium.
• Cysts usually multiple, bilateral.
• Some solitary cysts can be large.
• Multi-cyst areas have diffuse nodularities, and consistency increase.
• Some epithelial changes go on to sclerosing adenosis.

Inflammatory

• Most tenderness is inflammatory.
• DDx: abscess, mastitis (if started breast feeding, bacteria may have entered cracks), granulomas (sarcoidosis, Wegener's).

Fat necrosis

• Subtype of inflammatory, since inflammation follows necrosis.
• Usually Hx of trauma, surgery, or radiation Rx.
• Single breast.
• Isolated, sharply localized.

Paget's dz of breast

• 50% have a palpable mass.
• Nipple eczema, inflammation, bleeding.

Chest wall sarcomas

• Breast area can have sarcomas found elsewhere in chest.
• Examples: liposacroma, chondrosarcoma, leiomyosarcoma, osteosarcoma.

Hyperplasia

• Ductal and lobular subtypes.
• Proliferative dz, like fibrocystic change.

Male gynecomastia

• Under areola, can palpate disc of tissue not found in obese men.

Tietze's disease

• Swelling, discomfort of costochondral, costosternal joints.
• Painful on palpation, may be perceived as breast pain.