A45-year-old woman has bilateral breast pain that is most severe premenstrually. On palpation, there is excessive nodularity, tenderness, and cystic areas that diminish in size after menses. Which of the following is the most likely diagnosis?
- fibrocystic disease
- fibroadenomas
- intraductal papilloma
- breast cancer
- engorgement attributable to increased prolactin
Answer(s): A
Explanation:
The classic symptom of fibrocystic breast disease is cyclic bilateral breast pain. The pain and associated diffuse breast engorgement is most severe premenstrually. Cystic changes palpated premenstrually typically are smaller postmenstrually. Fibroadenomas are firm, rubbery, freely mobile, solid, and usually solitary masses. Intraductal papilloma does not cause diffuse breast symptoms. Spontaneous and intermittent nipple discharge is the classic sign of an intraductal papilloma. Intraductal carcinoma is more likely if there is a discharge from multiple ducts. Breast cancer should be suspected when a solitary firm nodule does not change throughout the menstrual cycle. A mammogram is helpful, but any suspicious mass should be biopsied. Hyperprolactinemia can cause breast engorgement, but the pain is usually mild, and cystic areas tend not to vary in size