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Case 6

Case History

A 48-year-old woman, status post lumpectomy 16 months ago. She now has a small palpable lump in her lumpectomy site. She is initially studied sonographically. Upon discovery of a sonographic nodule, mammographic examination has been performed.

Physical Examination

• left breast: 8 mm lump at the 6:00 position within the scar of her lumpectomy site

• right breast: normal exam

Mammogram

Mass (Fig. 6–1)

• margin: circumscribed

• shape: oval

• density: fat-containing

Figure 6–1. Left MLO magnification spot mammogram: In the region of the patient's lumpectomy site there is an oval radiolucent nodule.

Ultrasound

Frequency

• 13 MHz

Mass

• margin: well defined

• echogenicity: hypoechoic

• retrotumoral acoustic appearance: no shadowing

• shape: ellipsoid (Fig. 6–2)

Figure 6–2. Left antiradial breast sonogram: A well-defined oval nodule corresponds to the palpable lump and the oval mammographic lucency. The nodule has a thin hyperechoic rim and a hypoechoic center.

Pathology

• oil cyst

Management

• BI-RADS Assessment Category 2, benign finding

Pearls and Pitfalls

The ultrasound nodule is consistent with either an organizing hematoma or an oil cyst. However, the mammographic fat density of the nodule is diagnostic of an oil cyst.