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Case 9

Case History

A 43-year-old woman presents for screening mammogram.

Physical Examination

• bilateral lumpy breasts; no new lumps

Mammogram

Mass (Fig. 9–1)

• margin: circumscribed

• shape: oval

• density: equal density

Figure 9–1. In the upper outer quadrant of the right breast there is an oval mass. Part of its margin is obscured by surrounding dense tissue and part of the margin is associated with a lucent halo. (A). Right MLO mammogram. (B). Right CC mammogram.

Ultrasound

Frequency

• 10 MHz

Mass

• margin: well defined

• echogenicity: anechoic

• retrotumoral acoustic appearance: increased acoustic transmission

• shape: ellipsoid (Fig. 9–2)

Figure 9–2. Right radial breast sonogram: The mass identified in Figure 9–1 corresponds to a simple cyst. The fluid collection is anechoic with increased acoustic transmission.

Pathology

• cyst

Management

• BI-RADS Assessment Category 2, benign finding

Pearls and Pitfalls

1. Cysts are a component of fibrocystic change. This entity is considered a physiologic developmental process in which there is cystic dilatation of the terminal duct/lobular units. As a result of this origin, the cysts are lined either with epithelial-myoepithelial cells or by metaplastic apocrine cells.

2. Sonography is an excellent method to identify cysts and has been shown to accurately identify cysts in 96 to 100% of cases. As long as the wall of the cyst is well defined, thin, and hyperechoic, small moving particles within a cyst are generally not clinically significant.

Suggested Readings

1. Azzopardi JGK. Problems in Breast Pathology. Philadelphia: WB Saunders; 1979:57–72.

2. Murad TM, von Haam E. The ultrastructure of fibrocystic disease of the breast. Cancer 1968;22:587–600.

3. Tavassoli FA. Benign lesions. In: Tavassoli FA, Fattaneh A, eds. Pathology of the Breast. 2^nd ed. Stamford: Appleton and Lange; 1999:115–204.

4. Hilton SVW, Leopold GR, Olson LK, Willson SA. Realtime breast sonography: application in 300 consecutive patients. AJR 1988;150:789–790.

5. Jellins J, Kossoff G, Reeve TS. Detection and classification of liquid-filed masses in the breast by gray scale echography. Radiology 1977;125:205–212.

6. Sickles EA, Filly RA, Callen PW. Benign breast lesions: ultrasound detection and diagnosis. Radiology 1984;151:467–470.