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Case 10

Case History

A 51-year-old woman presents for screening mammogram.

Physical Examination

• normal exam

Mammogram

Mass (Fig. 10–1)

• margin: circumscribed

• shape: oval

• density: equal density

Figure 10–1. In the upper inner quadrant of the right breast, there are two dominant well-defined oval masses. (A). Right MLO mammogram. (B). Right CC mammogram.

Ultrasound

Frequency

• 11.5 MHz

Mass

• margin: well defined

• echogenicity: anechoic

• retrotumoral acoustic appearance: increased acoustic transmission

• shape: ellipsoid (Fig. 10–2)

Figure 10–2. Right transverse breast sonogram: The two Mammographic masses correspond to two cysts. The fluid collections are anechoic; have well-defined, thin, hyperechoic walls; and have increased acoustic transmission.

Pathology

• cysts

Management

• BI-RADS Assessment Category 2, benign finding

Pearls and Pitfalls

Cysts are a component of fibrocystic change. This process has been identified clinically in about one third of women between 20 and 45 years of age. Autopsy studies have found about 54% of normal breasts have histologic evidence of cystic changes.

Suggested Readings

1. Frantz VX, Pickren JW, Melcher GE, et al. Incidence of chronic cystic disease in so called “normal breasts.” A study based on 225 postmortem examinations. Cancer 1951;4:762–783.

2. Jones BM, Bradbeber JW. The presentation and progress of macroscopic breast cysts. Br J Surg 1980;67:669–671.

3. Leis HP, Kwon CS. Fibrocystic disease of the breast. J Reprod Med 1979;22:291–296.

4. Leis HP Jr. Fibrocystic disease of the breast. J Med Assoc Alabama 1962;32:97–104.

5. Love SM, Gelman RS, Silen W. Fibrocystic “disease” of the breast—a non-disease. N Engl J Med 1982;307:1010–1014.