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Musculoskeletal/Small parts » Breast
Breast cyst in a teenage girl.
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Presentation This 14 year old girl presented with a small palpable, painful mass in the left breast.
 
 
 
Caption: Sagittal sonogram of palpable abnormality.
Description: Small, well defined, anechoic cyst is seen in the left breast.
 
 
 
Caption: Transverse sonogram, left breast palpable mass.
Description: Small, well defined anechoic cyst.
 
Differential Diagnosis cyst
solid mass- fibroadenoma, cystosarcoma phylloides
dilated duct
abscess
 
Final Diagnosis Simple breast cyst.
 
Discussion The imaging modality of choice in a teenage girl with a palpable mass is ultrasound. The differential diagnosis includes benign solid masses, such as fibroadenoma or focal glandular breast tissue. Cysts, focally dilated ducts and abscesses are alternative considerations.

Breast cysts in pediatric and adolescent girls usually arise neaer the areola. They can be anechoic or complex with internal echoes. The etiology is dilation of the lobular acini.

A dilated or ectatic duct can also present as a palpable mass. These are generally elongated, and may be anechoic or contain internal debris. Infectious fluid collections unrelated to lactation usually arise in patients with predisposing conditions, such as diabetes or those who take steroids.

Discrete solid masses are most commonly fibroadenomas in this age group. The typical ultrasound appearance is a well-circumscribed oval or round mass. The mass usually demonstrates decreased echogenicity and is homogeneous. In 10-15%, multiple fibroadenomas are present.

Malignancy is very uncommon in this age group. The most common primary malignant mass in an adolescent is cystosarcoma phylloides. This mass appears as a smoothly marginated lesion which may be lobulated. It can contain cystic areas internally. It is more likely that a malignant mass in a child arises secondary to lymphoma, leukemia or metastatic neuroblastoma or rhabdomyosarcoma.
 
Case References (1) Weinstein Sp, Conant EF, Orel SG et al. Spectrum of US Findings in Pediatric and Adolescent Patients with Palpable Breast Masses. Radiographics 2000; 20: 1613-1621.

(2) Garcia CJ, Espinoza A, Dinamarca V et al. Breast US in Children and Adolescents. Radiographics 2000; 20: 1605-1612.
 
Technical Details GE, Logiq700, 5-10 MHz linear transducer
 
Follow Up The cyst spontaneously resolved.
 
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