Oil cysts in breast imaging refer to benign breast lesions where an area of focal fat necrosis becomes walled off by fibrous tissue.
Occurs across all age and ethnic groups with a female predilection. Usually associated with blunt trauma, if present in males.
- usually asymptomatic
- tender or non-tender palpable lump
- bruising, if recent trauma
Fat debris from ruptured lipocytes tends to conglomerate to form a macroscopic pool of oil surrounded by lipid-laden macrophages or foam cells - known as an oil cyst. The wall can then calcify. Most often this occurs secondary to trauma or surgery; however, this is not always necessary.
The etiology of oil cysts is felt to be most often an end-form of liquefaction fat necrosis of the breast resulting from trauma or surgery. However, some oil cysts arise independently, without a prior history of trauma or surgery.
Specimens are usually obtained from surgical excision or aspiration. Grossly, appears as viscus, oily fluid/material.
Fat-filled macrophages and foreign body giant cells are usually present. There may be hemorrhage into fat. A fibrous capsule forms around the lipid contents. Following fatty acid saponification, there may be calcific precipitation.
Multiple intradermal oil cysts can be part of steatocystoma multiplex.
Typically seen as a radiolucent rounded mass of fat density +/- wall calcification, which if present typically appears as eggshell calcification. Lesions are usually well-circumscribed with a thin capsule. Rarely, fat-fluid levels may be present.
On ultrasound, most oil cysts are hypo-echoic with smooth walls and show neither posterior acoustic enhancement or shadowing. Echogenicity varies. Fat-fluid levels are better characterized sonographically. When present, rim calcifications will demonstrate posterior acoustic shadowing. Complex features include thick walls, mural nodularity, and internal echoic bands. A very small proportion can represent an intracystic mass.
Circumscribed, lucent, non-enhancing lesion +/- calcification.
T1WI: circumscribed, hyperintense lesion (isointense to fat)
Treatment and prognosis
Treatment is usually not required. Aspiration/biopsy is not recommended due to the inflammatory nature of oil contents.
- fat necrosis
- intramammary lipoma
- on ultrasound, an oil cyst and seroma are often indistinguishable
- Steatocystoma multiplex
- zystische Läsionen der Mamma
- Ölzysten in der Mamma nach Trauma