• 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. 2nd 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.
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.
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)