ABSTRACT
Retroareolar cysts (RCs) are a benign self-resolving condition primarily affecting pubertal individuals. However, their presentation as asymptomatic bluish areolar lumps remains underreported in the literature, with only six cases previously documented. This lack of awareness may lead to the oversight of RCs during diagnosis. To address this, we conducted a comprehensive literature review using PUBMED, and we further added three more cases. The mean time for clinical resolution was found to be 2.3 years. In light of these findings, we proposed a diagnostic and management algorithm to guide clinicians in their approach to RCs in pediatric patients. The algorithm involves thorough clinical examination, medical history assessment, and echographic investigation with color Doppler analysis. Regular follow-up visits are recommended until resolution of the lesions. Notably, due to the consistently favorable outcome of RCs, aggressive diagnostic interventions can be avoided, providing reassurance to patients and their families. It is crucial for paediatricians to stay updated on this underreported condition to ensure timely recognition and appropriate management. Dermatologists should be the first specialists to be consulted in cases of suspected RCs. Increasing awareness among healthcare professionals will contribute to improved diagnosis and management of this benign condition. In conclusion, RCs are a benign self-resolving condition commonly observed during puberty. Their presentation as asymptomatic bluish areolar lumps may often be overlooked. Through this study, we highlighted the importance of early recognition, proposed a diagnostic and management algorithm, and emphasized the favorable prognosis of RCs, which allows for a conservative approach to their management.
Subject(s)
Puberty , Humans , Female , Adolescent , Breast Cyst/diagnosis , Child , Algorithms , Diagnosis, DifferentialABSTRACT
Clinical and pathologic characteristics of the invasive ductal carcinoma (IDC) presenting as a thick-walled breast cyst are little known. Three female patients were included in this report. A palpable, nontender breast lump was found in all cases. While mammography showed a hyperdense mass, ultrasonography demonstrated a thick-walled cystic mass. Magnetic resonance imaging clearly showed the cystic breast lesions with ring-like or irregular rim enhancement. A grade III IDC was confirmed in all cases. All IDCs but one were estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 negative, with merely weak progesterone receptor positivity (5%) in one case. All cases underwent surgical management first and postoperative chemotherapy. Breast malignancy presenting as a thick-walled cystic mass could be a highly aggressive IDC, even triple-negative breast cancer. It is imperative for breast cancer-related practitioners to identify the potentially malignant cystic lesions timely and adopt appropriate management.
Subject(s)
Carcinoma, Ductal, Breast , Triple Negative Breast Neoplasms , Adult , Female , Humans , Middle Aged , Breast Cyst/diagnosis , Breast Cyst/pathology , Breast Cyst/diagnostic imaging , Breast Cyst/surgery , Breast Neoplasms/pathology , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Breast Neoplasms/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/surgery , Magnetic Resonance Imaging , Mammography , Triple Negative Breast Neoplasms/pathology , Triple Negative Breast Neoplasms/surgery , Triple Negative Breast Neoplasms/diagnosis , Ultrasonography, MammaryABSTRACT
Breast cyst, especially galactocele is usually benign. Needle aspiration or surgical removal are both diagnostic and therapeutic. Mastectomy is not necessary even if the whole breast is affected, but surgeons need to be vigilant. We describe a rare case of persistent and large breast cyst.
Subject(s)
Breast Cyst , Breast Neoplasms , Humans , Female , Breast Cyst/diagnosis , Breast Cyst/surgery , Breast Cyst/pathology , Breast Neoplasms/diagnosis , Mastectomy , Biopsy, NeedleABSTRACT
Galactoceles are the common benign cystic breast lesions during pregnancy and lactation. This report describes the cytological findings of a case of long standing galactocele which underwent crystallization and mimicked carcinoma clinically as well as on sonography. A young woman presented with a hard painless lump in the right breast. She noticed the lump during her pregnancy 2.5 years back. Clinically the lesion was hard and sonography was equivocal in categorizing the lesion. An FNAC was performed which showed granular amorphous material along with crystals of various shapes and sizes. A diagnosis of crystallizing galactocele was made and woman was assured about the benign nature of the lesion. The cytological findings of crystallizing galactocele have been reported in very few cases. In the present case, a detailed history and clinical examination followed by fine needle aspiration established the diagnosis of crystallizing galactocele.
Subject(s)
Breast Cyst , Breast Neoplasms , Fibrocystic Breast Disease , Breast/pathology , Breast Cyst/diagnosis , Breast Cyst/pathology , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Female , Fibrocystic Breast Disease/pathology , Humans , Lactation , PregnancyABSTRACT
ABSTRACT: The aim of this study was to develop a new breast density classification system for dedicated breast computed tomography (BCT) based on lesion detectability analogous to the ACR BI-RADS breast density scale for mammography, and to evaluate its interrater reliability.In this retrospective study, 1454 BCT examinations without contrast media were screened for suitability. Excluding datasets without additional ultrasound and exams without any detected lesions resulted in 114 BCT examinations. Based on lesion detectability, an atlas-based BCT density (BCTD) classification system of breast parenchyma was defined using 4 categories. Interrater reliability was examined in 40 BCT datasets between 3 experienced radiologists.Among the included lesions were 63 cysts (55%), 18 fibroadenomas (16%), 7 lesions of fatty necrosis (6%), and 6 breast cancers (5%) with a median diameter of 11âmm. X-ray absorption was identical between lesions and breast tissue; therefore, the lack of fatty septae was identified as the most important criteria for the presence of lesions in glandular tissue. Applying a lesion diameter of 10âmm as desired cut-off for the recommendation of an additional ultrasound, an atlas of 4 BCTD categories was defined resulting in a distribution of 17.5% for density A, 39.5% (B), 31.6% (C), and 11.4% (D) with an intraclass correlation coefficient (ICC) among 3 readers of 0.85 to 0.87.We propose a dedicated atlas-based BCTD classification system, which is calibrated to lesion detectability. The new classification system exhibits a high interrater reliability and may be used for the decision whether additional ultrasound is recommended.
Subject(s)
Breast Neoplasms/diagnosis , Breast/diagnostic imaging , Decision Support Techniques , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Breast/physiopathology , Breast Cyst/diagnosis , Breast Density/physiology , Breast Neoplasms/physiopathology , Clinical Decision-Making/methods , Datasets as Topic , Diagnosis, Differential , Fat Necrosis/diagnosis , Female , Humans , Middle Aged , Observer Variation , Reproducibility of Results , Retrospective Studies , Terminology as Topic , Ultrasonography, MammaryABSTRACT
BACKGROUND: Breast augmentation with fat grafting is used as an alternative to breast implants. However, a systematic evaluation of the complication rates after fat grafting using only studies with consecutive patients has not previously been performed. In this study, the authors compiled studies reporting complication rates and radiologic changes in consecutive patients undergoing cosmetic breast augmentation with fat grafting. METHODS: Studies reporting on consecutive patients undergoing breast augmentation with fat grafting were included. Complication rates, radiologic changes, Breast Imaging Reporting and Data System assessments, and the number of patients undergoing revision surgery were extracted. Mean complication rates and radiologic changes were calculated with meta-analytical methods. RESULTS: Twenty-two studies with 2073 patients were included. The rates of major complications were low (hematoma, 0.5 percent; infection, 0.6 percent; and seroma, 0.1 percent). None of these patients needed revision surgery. The most frequent minor complication was palpable cysts in 2.0 percent of the patients; 67 percent of these were treated with aspiration. The radiologic changes in the patients after fat grafting were as follows: oil cysts, 6.5 percent; calcifications, 4.5 percent; and fat necrosis, 1.2 percent. The risk of being referred for additional radiologic imaging (e.g., to exclude malignant changes) was 16.4 percent, and the risk of being referred for biopsy was 3.2 percent. CONCLUSIONS: The complication rates after breast augmentation with fat grafting are low and support fat grafting as an alternative to breast augmentation with implants. The rates of radiologic changes are high after fat grafting, but the changes do not seem to have any therapeutic consequences for the patients.
Subject(s)
Adipose Tissue/transplantation , Breast Cyst/epidemiology , Calcinosis/epidemiology , Fat Necrosis/epidemiology , Mammaplasty/adverse effects , Postoperative Complications/epidemiology , Breast/diagnostic imaging , Breast/surgery , Breast Cyst/diagnosis , Breast Cyst/etiology , Calcinosis/diagnosis , Calcinosis/etiology , Fat Necrosis/diagnosis , Fat Necrosis/etiology , Female , Humans , Mammaplasty/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Transplantation, Autologous/adverse effects , Transplantation, Autologous/methods , Treatment OutcomeABSTRACT
Galactocele, although a common cytological diagnosis in females, is not previously reported as a cause of breast enlargement in adult males. Hyperprolactinemia is the principal cause of galactocele in male breast. Besides drug induced hyperprolactinemia, other anatomical lesions of hypothalamo-pituitary region and different medical conditions like cirrhosis and chronic kidney disease are to be considered along with a full evaluation of features revealing hypogonadism in case of galactocele. Aspirated milk from the male breast is the primary clue for this detailed investigation process. Here we are presenting the first case of galactocele of the male breast due to hypogonadotropic hypogonadism with idiopathic hyperprolactinemia.
Subject(s)
Breast Cyst/pathology , Breast/abnormalities , Hyperprolactinemia/pathology , Hypertrophy/pathology , Breast/pathology , Breast Cyst/diagnosis , Epithelial Cells/pathology , Humans , Hyperprolactinemia/diagnosis , Hypertrophy/diagnosis , Male , Middle AgedABSTRACT
BACKGROUND: Breast augmentation is one of the most frequently performed esthetic operations. Galactorrhea and galactocele formation are both very rare complications. The real cause still remains unknown, but various risk factors have been well reported in the literature. This report concerns a case of postoperative galactocele following bilateral breast augmentation via the inframammary approach with dual-plane insertion of implants, which is usually considered a protective approach in terms of risk factors for induction of postoperative galactorrhea. METHODS: The patient had no significant surgical, gynecological or medical history, including galactorrhea or hyperprolactinemia, and did not present any chest wall abnormalities. There has been no use of oral contraceptives or any other drugs. After the surgical procedure, the patient presented with infection-like symptoms, for which galactorrhea or galactocele was initially not considered, mainly for the absence of specific risk factors. RESULTS: After antibiotic and bromocriptine therapy, her breast returned to normal, with no pain, inflammation, enlargement or esthetic alterations. After 6 months of follow-up, the patient did not present any abnormality and she was satisfied with the result. CONCLUSION: With our report, we want to underline that galactorrhea and galactocele cannot be ruled out, even in patients with no risk factors and with procedures considered as "protective." With a fast diagnosis and a specific therapy, implants and final result can be rescued. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Subject(s)
Amenorrhea/etiology , Breast Cyst/etiology , Breast Implants/adverse effects , Galactorrhea/etiology , Mammaplasty/adverse effects , Postoperative Complications/etiology , Silicone Gels , Amenorrhea/diagnosis , Breast Cyst/diagnosis , Female , Galactorrhea/diagnosis , Humans , Postoperative Complications/diagnosis , Young AdultABSTRACT
Intracystic breast carcinoma is a rare clinical entity accounting for 0.5-2% of all breast cancers. It represents a distinctive clinical form rather a histological subtype of breast cancer and can either be in situ or invasive tumor. We herein describe a rare case of intracystic breast carcinoma arising from the wall of a cyst in a postmenopausal patient, who presented with a rapidly growing complex breast cyst. Diagnostic evaluation and management of the patient are discussed along with a review of the literature. Complex breast cysts may represent a diagnostic and therapeutic challenge. An underlying malignancy has been reported in 21-31% of the cases. Preoperative diagnosis is challenging. Complex breast cysts with thick wall, thick inner septations, and intracystic solid components should undergo histological evaluation in order to rule out an underlying malignancy. The cytological analysis may be inconclusive. Ultrasound-guided biopsy is the diagnostic modality of choice. The correlation of clinical features, with imaging and histopathological findings is very important for the optimal treatment. In cases of discordance, a complete surgical excision is necessary with careful assessment of the extent of the disease and appropriate treatment.
Subject(s)
Breast Cyst/diagnosis , Breast Cyst/pathology , Breast Neoplasms/diagnosis , Aged, 80 and over , Breast/pathology , Breast Neoplasms/classification , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Papillary/pathology , Diagnosis, Differential , Disease Management , Female , Humans , Image-Guided Biopsy , Postmenopause , Tomography, X-Ray ComputedABSTRACT
Crystallizing galactocele is a very rare entity which yields a viscous, chalky material on Fine Needle Aspiration Cytology (FNAC). FNAC is used both for diagnosis as well as treatment of this condition. We present here a case of 26 years old lactating female who presented with swelling in the right breast for 8 months. The swelling was firm, discrete, non-tender and mobile involving the upper inner quadrant of right breast. A diagnosis of benign breast disease, possibly fibroadenoma was made clinically. FNAC of the lesion yielded thick, milky and chalky material. Cytological smears showed numerous semitransparent crystals of varying size and shapes with angulated borders in a background of granular and amorphous debris along with frothy appearing micelles. These crystals show positive birefringence. Based on clinical history of lactation and typical cytological findings, a diagnosis of crystallizing galactocele was made. We report this case because of rarity of this condition and to the best of our knowledge, till date only five cases of crystallizing galactocele has been reported in medical literature.
Subject(s)
Breast Cyst/diagnosis , Fibrocystic Breast Disease/diagnosis , Adult , Biopsy, Fine-Needle , Birefringence , Breast Cyst/pathology , Breast Feeding , Crystallization , Cyst Fluid/chemistry , Female , Fibrocystic Breast Disease/pathology , Humans , LactationABSTRACT
A 45-year-old woman previously fit and well, developed a pseudoaneurysm of the breast following core needle biopsy. She was ultimately reassured and discharged without further intervention. Pseudoaneurysm is a rare complication of core needle biopsy which, contrary to previously published cases, can be managed conservatively.
Subject(s)
Aneurysm, False/etiology , Biopsy, Large-Core Needle/adverse effects , Breast Diseases/etiology , Breast/blood supply , Aneurysm, False/therapy , Biopsy, Large-Core Needle/methods , Breast Cyst/diagnosis , Breast Diseases/therapy , Conservative Treatment/methods , Female , Humans , Middle AgedABSTRACT
Melanoma is the second most common non-hematopoietic malignancy after carcinomas to metastasize to the breast and often appears as a well-circumscribed, dense nodule on imaging. Although metastatic lesions presenting as bilateral cysts have been reported, this presentation is not common and may mimic benign breast cysts. We present a challenging case of metastatic melanoma presenting as bilateral breast cysts with spindled cytomorphology in a patient with a history of mammary carcinoma. Discordance between the spindled cytomorphology and the morphology of the core biopsy, which was similar to the patient's primary breast cancer, allowed for entertainment of other tumors and disease processes. Confirmatory immunostaining of the cytology material with HMB-45 was important to establish the diagnosis of metastatic melanoma. Diagn. Cytopathol. 2017;45:446-451. © 2017 Wiley Periodicals, Inc.
Subject(s)
Biomarkers, Tumor/genetics , Breast Cyst/diagnosis , Breast Neoplasms/diagnosis , Melanoma/diagnosis , Skin Neoplasms/diagnosis , Biopsy, Large-Core Needle , Breast Cyst/genetics , Breast Cyst/pathology , Breast Neoplasms/genetics , Breast Neoplasms/secondary , Diagnosis, Differential , Female , Humans , Immunohistochemistry , MART-1 Antigen/genetics , Melanoma/genetics , Melanoma/secondary , Melanoma-Specific Antigens/genetics , Middle Aged , S100 Proteins/genetics , Skin Neoplasms/genetics , Skin Neoplasms/pathology , gp100 Melanoma AntigenSubject(s)
Breast Cyst/diagnosis , Breast Neoplasms/diagnosis , Carcinoma, Intraductal, Noninfiltrating/diagnosis , Neoplasms, Multiple Primary/diagnosis , Aged , Apocrine Glands/pathology , Breast Cyst/diagnostic imaging , Breast Cyst/pathology , Breast Cyst/surgery , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/surgery , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Mammography , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgeryABSTRACT
BACKGROUND: Galactoceles have been previously described as an unusual cause of benign breast enlargement in male infants and children. CASE: A 3-year-old prepubertal girl presented with a right-sided breast mass and was found to have a 4.4-cm hypoechoic cyst on ultrasound imaging with otherwise normal endocrine studies including prolactin levels. She underwent cyst aspiration which revealed milky fluid. Fat globules were identified with microscopic examination, confirming the diagnosis of a galactocele. Aspiration resolved the mass. SUMMARY AND CONCLUSION: The etiology of galactoceles in nonlactating women is poorly understood. Traditionally, treatment of these benign cysts in male children has been surgical excision. In prepubertal girls, conservative management by surveillance or needle aspiration is warranted to prevent damage to developing breast tissue.
Subject(s)
Breast Cyst/diagnosis , Breast/pathology , Breast/diagnostic imaging , Child, Preschool , Cysts/pathology , Female , HumansSubject(s)
Breast Cyst/diagnosis , Breast Cyst/surgery , Gynecomastia/diagnosis , Gynecomastia/surgery , Humans , Infant , Male , Treatment OutcomeABSTRACT
Introducción: Las enfermedades mamarias en niños y adolescentes de uno y otro sexo son poco frecuentes. Entre los tumores mamarios benignos, el galactocele es de rara aparición en la infancia y se caracteriza por la acumulación de fluido lechoso en una lesión quística mamaria. Caso clínico: Niño de 4 años de edad, previamente sano, que presenta una masa retromamaria izquierda indolora. La ecografía muestra una lesión quística que es extirpada con diagnóstico anatomopatológico de galactocele. Conclusiones: El galactocele debe considerarse una posible causa de tumor mamario benigno en la infancia. El diagnóstico anatomopatológico es clave y su exéresis resulta curativa. Finalmente, se precisan más estudios acerca de su etiología y fisiopatogenia, aún no esclarecidas (AU)
Introduction: Breast diseases in children and adolescents of both sexes are rare. Galactocele is an uncommon benign breast lesion in infants and children and is characterized by the accumulation of milky fluid in a mammary cystic lesion.Clinical case: 4 years previously healthy male presented with left breast enlargement. Ultrasound showed cystic lesion which was excised with the diagnosis of galactocele. Conclusions: Galactocele should be considered as a possible cause of benign breast tumors in infants. The microscopic examination is the key for the diagnosis and excision is curative. Finally, further investigations about its etiology and pathogenesis are necessary (AU)