Resultados citológicos por punción aspiración con aguja fina versus biopsia definitiva de nódulo sólido mamario imagenológicamente benigno / Cytological findings by fine needle aspiration versus definitive biopsy in apparently bening solid breast nodules

El nódulo mamario constituye uno de los principales motivos de consulta médica en la población femenina. Se realizó un estudio descriptivo transversal cuyo objetivo fue comparar los resultados citológicos por punción aspiración con aguja fina versus biopsia definitiva de nódulo sólido mamario imagenológicamente benigno en 31 pacientes que asistieron al Servicio de Cirugía Ambulatoria del Hospital Central Universitario Dr. Antonio María Pineda y a un centro privado. La mayor prevalencia de nódulos se observó en el grupo etario de 21 a 30 años (35,48%), siendo el 66,67% ecográficamente BIRADS 3; por hallazgos mamográficos sólo se reportó BIRADS 3 y BIRADS 4a en 11,11% de los casos, respectivamente. Los resultados citológicos de la PAAF demuestran que el fibroadenoma fue la más frecuente de las lesiones benignas (69,44%) mientras que los resultados histopatológicos evidencian un 88,88% de casos de fibroadenoma y 5,56% de casos de condición fibroquística y tumor phyllodes benigno, respectivamente. Hubo una concordancia de 100% entre los resultados citológicos obtenidos por PAAF y los resultados histológicos obtenidos por biopsia(AU)

Breast nodules are one of the most common causes of medical consultation in women. A descriptive cross-sectional study was carried out in order to compare cytological findings by fine needle aspiration versus definitive biopsy in apparently benign solid breast nodules in 31 patients who attended the Servicio de Cirugía Ambulatoria of the Hospital Central Universitario Dr. Antonio Maria Pineda and a private clinic. The highest nodule prevalence was observed in the 21-30 years old group (35.48%) being sonographically BIRADS 3 in 66.67% of cases; by mammography, BIRADS 3 and BIRADS 4a was only present in 11.11% of cases, respectively. The most common lesion by fine needle aspiration was fibroadenoma (69.44%). The most common lesion by biopsy was fibroadenoma (88.88%) and fibrocystic condition and benign phyllodes tumor in 5.56% of cases, respectively. There was a 100% agreement between cytological findings obtained by fine needle aspiration and histological results obtained by biopsy(AU)

Birads 3: correlacion histopatologica de bajo potencial de malignidad, con conglomerados quisticos imagenologicos en pacientes de tegucigalpa / Birads 3: correlation of low histopathological potential for malignancy with breast clustered microcysts in patients from tegucigalpa

La categoría 3 del Breast Imaging Reporting and Data System (BIRADS) son hallazgos probablemente benignos y en menos del 2% de estos existe la posibilidad de carcinoma. El establecimiento de esta categoría precisa la realización de pruebas complementarias de imagen que incluye: proyecciones mamográficas adicionales, la ecografía, comparar las imágenes actuales con los estudios previos de la paciente y en casos especiales se recurre a la biopsia. Dentro de esta categoría se incluyen los conglomerados quísticos en los que se centró este estudio. Objetivo: Correlacionar hallazgos ecográficos y mamográficos, con estudio histopatológico de lesiones categorizadas como conglomerados quísticos (en imagenología). Población y Métodos: Pacientes que acuden al Hospital de Especialidades del Instituto Hondureño de Seguridad Social a quienes se les realizó mamografía y ecografía categorizadas como BIRADS 3 a las cuales se les confirmó diagnóstico mediante biopsia. Resultados: De las pacientes categorizadas BI-RADS 3, a 55(100%) se les realizó biopsia, el reporte histopatológico corroboró patología benigna en 55(100%) y no se encontró patología maligna. Discusión: Los conglomerados quísticos de mama son relativamente comunes, observados en ecografía en el 5,8% de los casos, ecográficamente, se observa un nódulo circunscrito, microlobulado u oval, compuesto de múltiples quistes pequeños adyacentes separados por tabiques delgados. Se encuentra generalmente como hallazgo incidental en mamografía, ecografía o en ambos.

Category 3 of the Breast Imaging Reporting and Data System (BIRADS) are probably benign findings and in less than 2% of these there is the possibility of carcinoma. The establishment of this category requires the performance of complementary imaging tests that include: additional mammographic projections, ultrasound, compare current images with previous studies of the patient and in special cases, biopsy is used. This category includes the cystic conglomerates that this study focused on. Objective: To correlate ultrasound and mammographic findings, with histopathological study of lesions categorized as cystic conglomerates (in imaging). Population and Methods: Patients who attend the Specialties Hospital of the Honduran Social Security Institute, who underwent mammography and ultrasound categorized as BIRADS 3, which were confirmed by biopsy. Results: Of the patients categorized BI-RADS 3, to 55 (100%) a biopsy was performed, the histopathological report corroborated benign pathology in 55 (100%) and no malignant pathology was found. Discussion: The breast cystic conglomerates are relatively common, observed in ultrasound in 5.8% of cases, ultrasound, we can observe a circumscribed, microlobulated or oval nodule, composed of multiple small adjacent cysts separated by thin septa. It is usually found as an incidental finding on mammography, ultrasound or both.

Cysts within Otherwise Probably Benign Solid Breast Masses and the Risk of Malignancy / Cistos no interior de nódulo mamários benignos: risco de malignidade

Abstract Objective The objective of this study is to assess whether the largest cyst diameter is useful for BI-RADS ultrasonography classification of predominantly solid breast masses with an oval shape, circumscribed margins, and largest axis parallel to the skin, which, except for the cystic component, would be likely classified as benign. Methods This study received approval from the local institutional review board. From March 2009 to August 2014, we prospectively biopsied 170 breast masses from 164 women. We grouped the largest cyst and mass diameters according to histopathological diagnoses. We used Student's t-test, linear regression, and the area under the receiver operating characteristic curve (AUC) for statistical assessment. Results Histopathological examination revealed 143 (84%) benign and 27 (16%) malignant masses. The mean largest mass diameter was larger among malignant (mean standard deviation, 34.1 16.6 mm) than benign masses (24.7 16.7 mm) (P < 0.008). The mean largest cyst diameter was also larger among malignant (9.9 7.1 mm) than benign masses (4.6 3.6 mm) (P < 0.001). Agreement between measurements of the largest mass and cyst diameters was low (R2 = 0.26). AUC for the largest cyst diameter (0.78) was similar to the AUC for the largest mass diameter (0.69) ( p = 0.2). A largest cyst diameter < 3, 3 to < 11, and 11 mm had a positive predictive value of 0, 15, and 52%, respectively. Conclusion A largest cystic component < 3 mm identified within breast masses that show favorable characteristics may be considered clinically inconsequential in ultrasonography characterization. Conversely, masses with a largest cystic component 3 mm should be classified as BI-RADS-US category 4.

Resumo Objetivo Avaliar se o maior diâmetro do cisto é útil para a classificação ultrassonográfica BI-RADS de nódulos mamários predominantemente sólidos, com forma oval, margens circunscritas e maior eixo paralelo à pele que, exceto pela presença do componente cístico, seriam classificados como provavelmente benignos. Métodos Este estudo foi aprovado pelo Comitê de Ética local. De março de 2009 a agosto de 2014, 170 nódulos mamários de 164 mulheres foram prospectivamente biópsiados. As medidas do maior diâmetro do maior cisto e do maior diâmetro do nódulo foram agrupados de acordo com os diagnósticos histopatológicos. O teste t de Student, a regressão linear e a área sob a curva ROC (AUC) foram utilizados para a avaliação estatística. Resultados O exame histopatológico revelou 143 (84%) nódulos benignos e 27 (16%) nódulos malignos. A média da medida do maior diâmetro dos nódulos foi maior entre os nódulos malignos (média desvio padrão, 34,1 16,6 mm) do que nos nódulos benignos (24,7 16,7 mm) (p < 0,008). A média do maior diâmetro do maior cisto também foi maior entre os nódulos malignos (9,9 7,1 mm) do que nos nódulos benignos (4,6 3,6 mm) (p < 0,001). A concordância entre as medidas dos maiores diâmetros dos nódulos e do maior diâmetro do maior cisto foi baixa (R2 = 0,26). A AUC do maior diâmetro do maior cisto (0,78) foi semelhante à AUC do maior diâmetro do nódulo (0,69) (p = 0,2). Os maiores diâmetros dos maiores cistos medindo < 3; 3 e < 11; e 11 mm tiveram um valor preditivo positivo de 0, 15 e 52%, respectivamente. Conclusão Componentes císticos < 3 mm identificados dentro de nódulos mamários que apresentam as demais características provavelmente benignas podem ser considerados clinicamente irrelevantes na caracterização ultrassonográfica. Por outro lado, nódulos que apresentam um componente cístico medindo 3 mm devem ser classificadas na categoria BI-RADS-US 4.

Galactocele medicamentosa pós-mamoplastia de aumento: relato de caso e revisão da literatura / Galactocele due to drugs prescribed after augmentation mammoplasty: a case report and literature review

A mamoplastia de aumento é um procedimento cirúrgico muito comum e seguro na cirurgia plástica, mas o mesmo não está isento de complicações. A galactocele após mamoplastia de aumento é raramente descrita na literatura. Este relato de caso refere-se a uma paciente de 34 anos de idade, que fazia uso de sulpirida há 2 anos e 4 meses e desenvolveu galactocele cerca de 100 dias após mamoplastia de aumento. O diagnóstico deve ser suspeitado quando se observar uma mama aumentada de volume, associada a calor local, dor ou desconforto mamário no pós-operatório. Acredita-se que a melhor conduta seja a drenagem cirúrgica, a fim de confirmar o diagnóstico de galactocele e excluir a presença de abscesso mamário.

Augmentation mammaplasty is a common and safe plastic surgery procedure, but it is not free from complications. Galactocele after augmentation mammaplasty is rarely described in the literature. We discuss the case of a 34-year-old woman who had been taking sulpiride for 2 years and 4 months and developed galactocele approximately 100 days after augmentation mammaplasty. However, diagnosis should be suspected if breast size increases and it is associated with postoperative local heat, pain or breast discomfort. We believe that the surgeon must surgically drain galactocele to confirm diagnosis, especially to exclude the presence of breast abscess.

Hyperechoic Breast Lesions on Ultrasound:Easily Misdiagnosed Conditions / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the incidences of hyperechoic breast lesions and hyperechoic breast cancers in lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 on ultrasound and investigate their sonographic features and the underlying histological causes.</p><p><b>METHODS</b>The pathologic records for 848 sonographically guided core needle biopsies or surgical resection were retrospectively reviewed from June 2012 to March 2014. Hyperechoic lesions were identified and their sonographic features were evaluated. The incidence of hyperechoic breast lesions and the frequency of hyperechoic cancers among all hyperechoic breast lesions were calculated.</p><p><b>RESULTS</b>Of all 848 lesions, 0.9% (8/848) were hyperechoic. Twenty-five percent (2/8) of the hyperechoic lesions were malignant and the remaining six were benign. Among the 280 malignant lesions, 0.7%(2/280) were hyperechoic. The pathological basis of breast lesions presenting as hyperechoic nodules included inflammatory edema, galactoceles, and grit calcifications. Little difference of sonographic feature was found between benign and malignant hyperechoic lesions in this study.</p><p><b>CONCLUSIONS</b>Hyperechoic breast lesions are rare conditions but can be associated with a high ratio of breast cancer. History-taking and imaging techniques may help to avoid misdiagnosis.</p>

Complex Cysts of the Breast: Analysis using Sonographic Breast Imaging Reporting and Data System

PURPOSE: The purpose of this study was to evaluate the usefulness of sonographic BI-RADS in differentiation between benignity and malignancy of complex breast cysts. MATERIALS AND METHODS: Among 855 female patients who underwent ultrasound-guided core needle biopsy at our hospital from March 2012 through August 2012, 82 pathologically proven complex cysts detected on ultrasonography were included. The BI-RADS classification was made by radiologists prospectively and the imaging characterization of cystic lesions were classified retrospectively as cystic masses with a thick septa or thick wall, mixed solid and cystic masses, or solid masses with eccentric cystic foci. All lesions examined by ultrasonography were classified prospectively according to the BI-RADS lexicon. The pathologic findings were compared with sonographic appearance. We reviewed and compared the radiologic features between malignant lesions and benign lesions. RESULTS: Finally, according to biopsy results, there were 71 benign and 11 (13.4%) malignant lesions. The frequency of malignancy was significantly higher in solid masses with eccentric cystic foci (p value <0.025). The size of sonographic lesions was significantly larger in malignant lesions than in benign lesions (41.82 mm+/-34.36 vs 18.41 mm+/-16.8 respectively, p=0.049). No statistically significant difference was observed in the sonographic findings according to the BI-RADS lexicon, however, statistically significant difference in final assessment categories was observed between benign and malignant lesions (p value <0.001). CONCLUSIONS: The malignancy rate was higher in cystic lesions with predominantly solid masses and classified as suspicious malignancy using the BI-RADS lexicon.

Efícacia clínica de la Homeopatia aplicada em cirugía ambulatorial / Clinical efficacy of surgery em Homeopathy applied outpatient

El trabajo visa evaluar la eficacia del tratamiento homeopático em lasdiversas patologías en pacientes que asisten a consultas de cirugía ambulatoria, utilizando a terapéutica homeopática. Los resultados el tratamiento con homeopatía en las consultas de cirugía, lo que ayuda a mejorar el estado de salud del paciente y en caso de una intervención quirúrgica encontrarse en mejores codiciones.

Exame citológico do derrame papilar, fibroadenoma, lipoma, cistos mamários, papiloma intraductal e câncer de mama / Cytological examination of nipple discharge, fibroadenoma, lipoma, breast cysts, intraductal papilloma and breast cancer

O diagnóstico precoce de câncer de mama é realizado pelo autoexame das mamas, exame clínico das mamas, mamografia e pelo exame de ultrassonografia. Porém, outros exames que se destinam à confirmação cito-histopatológico consistem na citologia de material colhido por punção aspirativa, histopatologia do material colhido por punção aspirativa por agulha grossa e biópsia. A citologia é um importante instrumento de diagnóstico em diversas patologias pela sua simplicidade e precisão, tendo uma sensibilidade elevada. Esse exame é indispensável ao diagnóstico das lesões palpáveis da mama e junto com o exame físico e mamográfico fornecem o tríplice diagnóstico, elevando ainda mais a sensibilidade de detecção de qualquer patologia mamária, sem ter a necessidade de um procedimento mais agressivo. O objetivo desse estudo foi revisar algumas doenças das mamas com ênfase ao diagnóstico citopatológico. Foi realizada uma revisão da literatura em livros e artigos científicos de revistas impressas e eletrônicas disponíveis, que continham descrições dos aspectos citomorfológicos das patologias da mama.

Galactoceles al nivel del cuadrante inferoexterno de la mama izquierda / Galactocele at inferoexternal level of left breast

Paciente femenina de 25 años, la cual tuvo un parto hace 2 años y durante el período de la lactancia se notó la presencia de nódulos en la mama izquierda (MI). Al examen físico se constató, a la palpación, nódulos de consistencia firme, ligeramente movibles hacia el cuadrante inferoexterno (CIE). No presentaba secreción por el pezón ni otras alteraciones al nivel de ambas mamas. Se le realizó ultrasonido de ambas mamas (US) y mamografía (Mx), mediante los cuales se obtuvieron los siguientes hallazgos al nivel de la MI. Ambos estudios en la mama derecha no mostraron alteraciones

Characterization of Cystic Breast Masses on Ultrasound: Comparative Study among Conventional, Tissue Harmonic, Compound, and a Combination of Tissue Harmonic and Compound Imaging

PURPOSE: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US) techniques including tissue harmonic, compound, and the combination of these techniques. MATERIALS AND METHODS: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman's test and receiver operating characteristic (ROC) analyses. RESULTS: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). CONCLUSION: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.

Estudios percutáneos de mama: punción aspirativa con aguja fina / Percutaneous studies of the breast: fine needle aspiration

Procedimiento de diagnóstico de patologías benignas y malignas, del que se describe su uso en diagnósticos citológicos, aspiración diagnóstica y/o sintomatológica de quistes y/o formaciones líquidas, instilación de antibióticos en cavidades abscedadas, e instilación de contrastes en ductos.

Evaluación de los quistes complejos de mama / Assessment of the complex breast cysts

Detalles que deben tenerse en cuenta al realizar estudios ecográficos de las lesiones quísticas, especialmente en su visualización y en la interpretación diagnóstica: forma, pared, contenido, tabiques internos, formaciones intraquísticas, y artefactos...

Apresentação das lesões mamárias císticas à ultra-sonografia utilizando a elastografia / Features of cystic breast lesions at ultrasound elastography

OBJETIVO: Demonstrar a apresentação mais freqüente das lesões mamárias císticas utilizando a elastografia e discutir a sua aplicabilidade. MATERIAIS E MÉTODOS: A casuística compôs-se de 150 pacientes encaminhadas para realização de biópsia mamária percutânea com 175 lesões. Foram excluídas as lesões com diagnóstico histológico de lesões sólidas (153 lesões) e incluídas as lesões com características císticas à histologia (22 lesões), incluindo cistos complicados, lesões papilíferas, lesões inflamatórias, hiperplasia de células colunares típica e ectasia ductal. Estas lesões foram classificadas de forma retrospectiva por meio da elastografia, conforme escores criados pelos autores, variando de 1 a 4. RESULTADOS: Das 22 lesões encaminhadas, 13 (59 por cento) correspondiam a cistos, uma (4,6 por cento) a ectasia ductal, duas (9,2 por cento) a lesões inflamatórias, cinco (22,6 por cento) a lesões papilíferas e uma (4,6 por cento) a hiperplasia de células colunares. Foram encontrados 17 escores 2, quatro escores 3, um escore 4 e nenhum escore 1, com especificidade de 95 por cento. CONCLUSÃO: As lesões císticas mamárias têm diferentes apresentações à elastografia, conforme o resultado histológico, sendo este um método útil para a sua diferenciação e de fácil aplicabilidade na clínica diária.

OBJECTIVE: To demonstrate the most frequent features of cystic breast lesions at ultrasound elastography, discussing the applicability of this method. MATERIALS AND METHODS: The present casuistic included 150 patients referred for percutaneous breast biopsy of 175 lesions. Histologically diagnosed solid lesions (153 lesions) were excluded; lesions histologically diagnosed as cystic (22 lesions), including complicated cysts, papillary lesions, inflammatory lesions, typical columnar cell hyperplasia and duct ectasia were retrospectively classified by means of elastography, according to a scoring system developed by the authors, with categories ranging between 1 and 4. RESULTS: Thirteen (59 percent) of the 22 lesions evaluated corresponded to cysts, one (4.6 percent) to duct ectasia, two (9.2 percent) to inflammatory lesions, five (22.6 percent) to papillary lesions, and one (4.6 percent) to columnar cell hyperplasia. The scoring system was applied with the following results: 17 category 2 lesions, four category 3 lesions, one category 4 lesion, and none category 1 lesion, with a 95 percent specificity. CONCLUSION: Different features of cystic breast lesions are demonstrated by elastography according to histological results, representing a useful and easily applicable method for differentiating benign from malignant breast lesions.

Patologia benigna da mama / Mammary benign patology

A patologia benigna da mama é responsável por cerca de 80% das massas palpáveis. Seu diagnóstico diferencial é amplo, envolvendo distúrbios no desenvolvimento, doenças inflamatórias, alterações fobrocísticas, tumores benignos e doença mamária proliferativa, entre outros. O fibroadenoma, tumor benigno da mama, é a neoplasia mamária mais comum em pacientes menores de 35 anos, já os cistos são mais freqüentes na perimenopausa. O diagnóstico diferencial entre nódulos sólidos ou císticos poderá ser feito por meio da punção aspirativa com agulha fina ou pela ultra-sonografia. Nos nódulos císticos a punção por agulha fina além de diagnóstica, é conduta terapêutica. Neste artigo serão revisados aspectos dos diagnósticos diferenciados entre estes tumores, as abordagens terapêuticas e a associação entre tais patologias e câncer de mama.

Cistos mamários - qual o seu significado? / Breast cysts - what do they mean?

Os cistos fazem parte de uma variedade de alterações benignas da mama, designadas como mudanças fibrocísticas, e constituem uma das causas mais freqüentes de tumores mamários. O exame clínico, isoladamente, é incapaz de estabelecer o diagnóstico de um cisto mamário. Geralmente é uma lesão assintomática, sendo diagnosticada por métodos de imagem. A acurácia do ultra-som para a identificação de cistos é próxima dos 100 porcento quanto presente massa anecóica oval, redonda ou lobulada, de contorno circunscrito, com reforço acústico posterior. Segundo o sistema BI-RADS para ultra-sonografia, os cistos podem ser divididos em simples, microcistos agrupados, complicados e complexos, sendo classificados em : categoria 2 (benigna) os cistos simples, categoria 3 (provavelmente benigna) para os microcistos agrupados e os cistos complicados e categoria 4 (suspeita) para os cistos complexos. A abordagem terapêutica dos cistos mamários deve ser individualizada de acordo com sua apresentação e o perfil psicológico de cada paciente. Atualmente, não se justificam medidas radicais na abordagem terapêutica destas lesões, visto que sua natureza é eminentemente benigna. É mister que os ginecologistas e mastologistas estejam informados e atualizados para utilizar racionalmente os recursos propedêuticos, otimizando tanto o benefício psíquico e clínico das pacientes como os custos decorrentes de exames e terapêuticas desnecessárias na abordagem dos diferentes tipos de cistos mamários.

Primary hydatid cyst of the breast: a case report

Cystic hydatid disease is caused by the parasite Echinococcus granulosus. The breast is a rare primary site of hydatid disease that accounts for only 0.27% of all cases. The cyst is usually asymptomatic and should be included under differential diagnosis of a breast lump, especially in endemic areas of this disease. Herein, we described the biopsy-proven case of a 46-year-old woman with primary hydatid disease of left breast

Hamartoma folículo-sebáceo cístico simulando nódulo mamário: relato de caso / Folliculosebaceous cystic hamartoma simulating breast nodule: a case report

O presente artigo tem por objetivo relatar um caso de um paciente do sexo masculino, de 35 anos de idade, apresentando tumoração na mama esquerda. Após estudo pelos métodos de imagens habituais o paciente foi submetido a biópsia, que revelou o resultado de hamartoma folículo-sebáceo cístico. Os autores apresentam breve revisão da literatura científica sobre essa rara lesão na mama masculina e seu diagnóstico diferencial com lesões malignas.

We report a case of 35 year-old male patient presenting with a mass in the left breast. After conventional imaging examinations the patient was submitted to a biopsy, which showed folliculosebaceous cystic ham-artoma. The authors present a brief review of the literature on this rare lesion in the male breast and its differential diagnosis with malignant masses.

Acoustic streaming for assessing adnexal cysts / 대한산부인과학회지

OBJECTIVE: Acoustic streaming is movement of fluid or air due to a sound field. It is caused by a transfer of momentum form sound waves, and results in movement in the direction of wave propagation. While acoustic streaming has previously been noted in breast cyst fluid, the lateral ventricle of a premature infant and in blood, there has been very little evaluation of its clinical role. the purpose of this study was to determine whether acoustic streaming has clinical value in the differentiation between various ovarian and adnexal cysts. METHODS: We assessed 15 adnexal cysts, for which pathological diagnosis was available, for the presence of acoustic streaming during B-mode and color mapping evaluation. Case with totally solid lesions or cysts with anechoic contents were excluded. RESULTS: Acoustic streaming was detected in 5 (33%) of the cysts. Endometrioma (N=4) did not exhibit acoustic streaming in any case (P=0.004), while of the remaining 11 cysts 5 exhibited acoustic streaming. Dermoid cysts exhibited acoustic streaming in one of five (20%) cases. In addition acoustic streaming was noted in three of four (75%) mucinous cystadenoma, zero of one (0%) function cyst, one of one (100%) struma ovarii. CONCLUSION: Acoustic streaming is the first sonographic feature that may be able to exclude endometrioma as a possible diagnosis for an adnexal cysts.