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Case of the Month

May 2008

Patient Data: 53 year old female

Clinical Info: Large palpable mass without pain or signs of infection

Irregular cystic mass with a thick irregular wall and desmoplastic reaction around the cyst

Detail of another part of the cystic mass with a layer of debris

Part of the cystic mass with smaller cysts

Detail of another part of the mass. Because there were no signs of infection a multilocular breast abscess was not very likely. We aspirated some of the cysts under ultrasound guidance and biopsied the irregular cyst walls. The cytological and histological examination revealed malignancy. In this case it was a metaplastic carcinoma. Metaplastic carcinomas are less common breast tumors that often show a complex echogenicity with solid and cystic components related to necrosis and cystic degeneration found histopathologically. It can be very difficult to differentiate a multicystic metaplastic breast carcinoma from a multilocular breast abscess as can be seen in the next case of a 28 year old patient who visited our department a few days later, but in this case with a painful mass with signs of an infection.

The mass also contains cysts with an irregular thick wall

There are also smaller and larger cysts

Irregular cystic mass in the breast

Some of the cysts contain reflective material and are surrounded by hyperechoic inflamed fat which can not be differentiated from the desmoplastic reaction as can be seen in malignancy.
In this case no malignancy was found.

For more forms of malignant breast lesions see category

Günhan-Bilgen I, Memis A, Ustün EE, Zekioglu O, Ozdemir N Metaplastic carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation.AJR Am J Roentgenol. 2002 Jun;178(6):1421-5.

Park JM, Han BK, Moon WK, Choe YH, Ahn SH, Gong G. Metaplastic carcinoma of the breast: mammographic and sonographic findings.
J Clin Ultrasound. 2000 May;28(4):179-86.

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