The differential diagnosis of an inflamed breast in a lactating woman includes acute mastitis, abscess, and, very rarely, cancer. Breast infection in a nonlactating woman, on the other hand, is not as common. The differential diagnosis of inflammation includes duct ectasia, nonpuepural breast abscess, and cancer. Inflammatory breast cancer must be distinguished from mastitis. Whereas the breast tissue changes of mastitis are typically well circumscribed, inflammatory breast cancer generally involves at least one-third of the breast tissue, and edges are not well demarcated. 14 There may or may not be a palpable mass in inflammatory breast carcinoma. However, the breast usually increases in size. Due to the diffuse invasion of lymphatic channels by tumor cells, axillary nodal metastases are almost always present at the time of diagnosis. The classically described peau d'orange appearance of the breast is due to edema and thickening of the skin. The breast discoloration may have a uniform appearance or be seen in the dependent part of the breast. Nipple retraction, with dermatologic findings, may occur as the disease progresses. Prolonged use of antibiotics in patients thought to have mastitis may cause significant delays in the diagnosis and treatment of breast cancer. A breast specialist should be consulted for chronic breast infections.14
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