complicated breast cyst

Complicated breast cysts are one of the cystic breast lesions that show intracystic debris which may imitate a solid mass appearance. They should be carefully differentiated from a complex cyst and may require alternative management .

Radiographic features

Ultrasound
  • thin wall with or without posterior acoustic enhancement
  • homogenous hypoechoic content
  • low-level internal echoes which may change the shape with the patient position
  • sloping fluid-fluid levels

The challenge is to differentiate a complicated from a complex cyst as the low internal echoes of a complicated cyst may appear as a homogeneous hypoechoic mass .

If there is hemorrhagic or inflammatory debris which is adherent to the wall, applying power Doppler and detection of internal vascularity can positively prove it to be a solid mass lesion. On the other hand, Doppler cannot exclude it .

Treatment and prognosis

Complicated breast cysts have less than 2% risk of malignancy and are recommended to be reported as probably benign . Thus, the management is limited to :

  • short interval follow up
    • if the size changes over 6 months by >20%, a diagnostic biopsy is indicated
  • aspiration
    • indicated in a symptomatic patient to relieve the symptoms, newly detected cyst, and enlarged cysts

In all cases, if aspiration reveals serosanguineous fluid, then cytological analysis should be performed.

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