In the first case study, a 60-year-old female patient presents to the office with the complaint of greenish discharge from her left breast. The patient’s discharge is also often followed by pain and burning sensations in the breast. The last mammogram does not show any abnormalities, but the patient’s physical examination reveals the presence of a 1cm module in the breast. These symptoms and diagnostic tests can lead to a variety of diagnoses from non-cancerous to malignant conditions (Tharpe, Farley, & Jordan, 2017). However, the differential diagnoses, in this case, involve fibroadenoma, mammary duct ectasia, and intraductal papilloma.
The first differential diagnosis is mammary duct ectasia (MDE) – the blockage of the milk duct. The symptoms of MDE include a nipple discharge that is greenish, black or white, tenderness near the place of discharge, redness of the nipple, and nipple inversion (Song et al., 2018). Moreover, in some cases, MDE can also cause the development of a breast thickening or a mass located near the clogged duct. The patient’s symptoms, as well as the examination, show a resemblance to the description of MDE. It should be noted that MDE often occurs in older women in their postmenopausal stage (Song et al., 2018). A repeated diagnostic test of mammography should be performed to support the diagnosis.
The second possible diagnosis is fibroadenoma, a solid benign breast lump. Although it is usually found in younger women, older patients may also develop a fibroadenoma in their breast tissue (Kovatcheva et al., 2015). They are defined as firm, mobile, and round modules that do not present with any other symptoms. The description of the patient’s lump fits with the symptoms of this condition. However, the symptom of greenish discharge is not included, thus making this diagnosis less possible than others.
Finally, intraductal papilloma can be reviewed as a potential diagnosis. It is a benign tumor that grows is the milk duct. Its symptoms include the presence of a lump located near the nipple as well as discomfort and white or bloody nipple discharge (Dhull, Sen, Yadav, & Drall, 2017). It should be noted that the majority of cases involve the occurrence of one large lump near the nipple or multiple smaller lumps farther from the nipple (Dhull et al., 2017). Therefore, the patient’s examination does not appear to support this diagnosis fully.
Additional tests are necessary to eliminate the diagnoses of fibroadenoma and intraductal papilloma, but it is possible to suggest that MDE is a likely diagnosis for the patient. It should be noted that MDE does not always require pharmacological treatment as it can get better by itself (Schuiling & Likis, 2017). To eliminate or lower the presence of symptoms such as discharge, the patient may consider antibiotics to treat the infection of the mammary duct. For example, Amoxicillin can be used with the dosage of 500 mg orally every 12 hours (“Amoxicillin,” 2018). If the patient’s diagnosis is confirmed and her symptoms are persistent, she may undergo surgery to remove the affected milk duct.
Overall, the patient’s attention to her health should be highlighted as the best way to prevent breast cancer. She should be encouraged to perform regular self-examinations to locate any changes in the breast tissue. Moreover, she should learn that many conditions may resemble breast cancer, but they are not malignant. The patient should know that MDE does not increase the risk of breast cancer, but she should always visit a specialist if she notices a growth in her tissue or some other symptoms.
References
Amoxicillin. (2018). Web.
Dhull, V., Sen, J., Yadav, R., & Drall, N. (2017). Case series: Imaging features of intraductal papillomas in patients presenting as nipple discharge. International Journal of Research in Medical Sciences, 4(7), 2878-2882.
Kovatcheva, R., Guglielmina, J. N., Abehsera, M., Boulanger, L., Laurent, N., & Poncelet, E. (2015). Ultrasound-guided high-intensity focused ultrasound treatment of breast fibroadenoma—A multicenter experience. Journal of Therapeutic Ultrasound, 3(1), 1-8.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.
Song, L., Li, L., Liu, B., Yu, D., Sun, F., Guo, M.,… Zhang, F. (2018). Diagnostic evaluations of ultrasound and magnetic resonance imaging in mammary duct ectasia and breast cancer. Oncology Letters, 15(2), 1698-1706.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones and Bartlett Publishers.