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Palpable breast mass in a lactating woman
  1. M Goyal,
  2. T B Poulton,
  3. O Konez
  1. Department of Radiology, Aultman Hospital, 2600 Sixth Street, SW, Canton, Ohio 44710, USA
  1. Dr Poultonchestimagr{at}aol.com

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Answers on p 482.

A 35 year old woman noted a painless lump in her right breast during self examination. She was three months postpartum and had been breast feeding her daughter since birth. Her past medical history included three previous uneventful pregnancies, each followed by an uncomplicated period of breast feeding. She had no other significant illnesses in the past. Her mother had died of postmenopausal breast cancer. She had never been on oral contraceptives.

On examination, there was a mobile, non-tender, firm palpable mass of about 3 cm in the upper outer quadrant of the right breast, close to the nipple. There was no swelling or erythema of the overlying skin. Although the clinical impression favoured a benign breast mass, breast cancer was also considered.

High resolution ultrasound of the right breast revealed a solid, predominantly hypoechoic mass with somewhat heterogeneous echotexture. Some of the margins of the mass were indistinct causing it to blend with the surrounding breast parenchyma. The mass was ovoid, width greater than height, and there was considerable posterior acoustic enhancement. There was no evidence of calcifications and the overlying skin and subcutaneous fat were sonographically normal. Transverse and longitudinal ultrasound images of the mass are shown in fig1.

Figure 1

Longitudinal (left, with electronic cursors) and transverse (right, with arrows) ultrasound images of the palpable breast mass showing a solid 2.5 cm long, ovoid mass with its long axis parallel to the chest wall. Note the considerable posterior acoustic enhancement (arrowheads).

Questions

(1)
What is the differential diagnosis of a solid mass in a pregnant or lactating woman?
(2)
What further work-up is needed to confirm the diagnosis in this case?
(3)
What is the most likely diagnosis of this patient's palpable breast mass?

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