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Case of the Month

November 2005

Patient Data: 68 years old female

Clinical Info: Palpable mass with benign characteristics

Longitudinal image of a thick walled cyst with slightly irregular contour (left side of the image).

Transverse image of the same cyst.

Mammographic image of the cyst. Note the irregular contour of the lower part of the lesion.

Cranio-caudal view of the same lesion.

There is no hypervascularity of the cyst wall.

An ultrasound guided puncture of the cyst was performed. The fluid that was aspirated was hemorrhagic. The patient was relieved because the lump had disappeared.

Careful examination after the cyst puncture however revealed a 5 mm small stellate lesion (lower left arrow) next to the empty cyst (upper right arrow). The cytological examination of the cyst fluid did not show malignant cells. Because of the stellate lesion a biopsy was strongly advised.

Longitudinal image of the cyst and the stellate lesion after two weeks. The cyst is already partly filled with fluid. The fluid in the cyst was again aspirated and a biopsy was performed of the thick wall of the cyst. Also of course a biopsy was performed of the stellate lesion.

5 mm stellate lesion and biopsy needle in pre-fire position.

5 mm stellate lesion and biopsy needle through the lesion. The biopsy results of the cyst wall revealed no signs of malignancy. The biopsy of the stellate lesion however proved this mass to be malignant. In cases of an atypical irregular thick walled cyst, especially when there are no signs of acute infection, one should be aware of an underlying malignancy.

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Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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