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Case 11

Case History

A 48-year-old woman presents for screening mammogram.

Physical Examination

• no new breast lumps; both breasts normally lumpy

Mammogram

Mass (Fig. 11–1)

• margin: circumscribed

• shape: oval

• density: equal density

Figure 11–1. In the left inferior inner quadrant, there is a circumscribed mass. This mass was new compared to previous exams. (A). Left MLO mammogram. (B). Left CC mammogram. (C). Left CC spot compression mammogram.

Ultrasound

Frequency

• 7.5 MHz

Mass

• margin: well defined

• echogenicity: heterogeneous

• retrotumoral acoustic appearance: bilateral edge shadowing

• shape: ellipsoid (Fig. 11–2)

Figure 11–2. Left longitudinal breast sonogram: The mammographic mass corresponds to a well-defined sonographic mass that is predominantly isoechoic to fat with a few anechoic oval lucencies within it. This mass was biopsied and found to be a complex benign cyst.

Pathology

• cyst

Management

• BI-RADS Assessment Category 4, suspicious; biopsy should be considered

Pearls and Pitfalls

Sonography usually is successful in identifying benign cysts. However, occasionally, cysts exhibit internal echoes. These echoes may be caused by poor sonographic technique (e.g., gain settings too high), artifact (e.g., reverberation), proteinaceous debris, hemorrhage, infected debris, or cholesterol crystals. If the material completely moves, then the cyst is probably benign. However, if the material does not move, then an intracystic mass should be considered. In these cases, either aspiration or biopsy should be performed to identify intracystic tumors; 75% of solid intracystic masses are benign (mostly papillomas), 20% malignant, and 5% are phyllodes tumors.

Suggested Readings

1. Khaleghian R. Breast cysts: pitfalls in sonographic diagnosis. Australas Radiol 1993;37:192–194.

2. Sohn C, Blohmer J-U, Hamper UM. Fibrocystic changes and breast cysts. In: Sohn C, Blohmer J-U, Hamper UM, eds. Breast Ultrasound. New York: Thieme; 1999:75–90.

3. Stavros AT, Dennis MA. The ultrasound of breast pathology. In: Parker SH, Jobe WE, eds. Percutaneous Breast Biopsy. New York: Raven Press; 1993:111–127.