Expert: Claes-Gustaf Nordquist, M.D. - 1/12/2009

Question
one of my pt. aged 36 years,having 3 children,last child 4 years old,has a lump in her left breast upper part size about 6 cm since last 6 weeks.Actually,6 weeks ago,lump size was about 2-3 cm,firm in consistency,mild tenderness,,mobile,no lymphadenopathy,no nipple discharge,no change in color of skin overlying lump.i hv given TAB AUGMENTIN 625 mg tid(LATER ON INJ AUGMENTIN 1.2 GM BID ALSO GIVEN FOR 3 DAYS),T CIPROFLOXACIN 500 MG BID,T METRONIDAZOLE 250 TDS with NSAID,but there was no benefit and the lump increased in size and became more tender.USG  breast showed A HYPOECHOIC MASS PREDOMINANTLY SOLID WITH SOME CYSTIC AREAS MEASURING 6 CM IN RETROAREOLAR AREA.On the same day,aspiration done to rule out abscess and about 250 ml pus mixed with little blood came out.Cytology showed pus cells ana rbc only.After 48 hrs ,again aspiration done but abt 50 ml blood with some clots and very little pus came out.Again after 48 hrs,we send FNAC and the report  is as follows-smears and the cell block show an admixture of neutrophils and small lymphocytes together with mono nucleated and multinucleated giant cells with microbiopsies of benign lymphoid tissues suggesting
granulomatous mastitis with presence of intramammary lymph nodes.OTHER INVESTIGATION DONE CBC SHOWING HB  7.7 GM, MICROCYTIC HYPOCHROMIC ANEMIA.BLOOD SUGAR  FASTNG  97 MG.Since last 7 days,I hv not given any medication except occasinal NSAID.At present,the swellin is more firmer with very little tenderness.WHAT MAY BE THE REASON OF THIS LUMP/SWELLING ANA WHAT SHOULD BE THE TREATMENT PLAN?

Answer
Dear colleague, this is obviously NOT a cancer but at least partly an infection/inflammation - maybe in a fibrocystic area of her breast. On this site I ONLY deal with cancer cases because that is my specialty. So I strongly suggest that you discuss this with an experienced breast surgeon! I'm a medical oncologist & radiation therapist not a surgeon. Good luck!