J Korean Soc Radiol.  2011 Mar;64(3):273-279. 10.3348/jksr.2011.64.3.273.

Review of Breast Cancers That Can Mimic a Cystic Component: Ultrasonographic and Pathologic Correlations

Affiliations
  • 1Department of Radiology, Soonchunhyang University Hospital, Korea. ywchang@hosp.sch.ac.kr
  • 2Department of Radiology, Soonchunhyang Cheonan Hospital, Korea.
  • 3Department of Radiology, Soonchunhyang Gumi Hospital, Korea.
  • 4Department of Pathology, Soonchunhyang University Hospital, Korea.

Abstract

We illustrate the sonographic findings of malignant breast masses that can mimic a cystic component with pathologic correlations. The disease entities presented in this study include infiltrating ductal carcinoma, ductal carcinoma in situ (DCIS), papillary carcinoma, mucinous carcinoma, medullary carcinoma, metaplastic carcinoma, and a malignant phyllodes tumor. Malignant masses with a cystic component are often characterized by well-circumscribed round, oval, or lobular masses, thereby appearing benign on ultrasonography. On pathology, the cystic component of a malignant mass is identified by cystic degeneration, hemorrhage, necrosis, or ductal dilatation. If the mass is well-circumscribed with a cystic component, a biopsy should be considered in the analysis of the solid component within a mass.


MeSH Terms

Adenocarcinoma, Mucinous
Biopsy
Breast
Breast Cyst
Breast Neoplasms
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Carcinoma, Medullary
Carcinoma, Papillary
Dilatation
Hemorrhage
Hydrazines
Necrosis
Phyllodes Tumor
Hydrazines

Figure

  • Fig. 1 Invasive ductal carcinoma with cystic degeneration. A. Sonography showed a large ill-defined cystic mass (arrow) with a thick septa and a solid nodular component. B. Photography (original magnification, × 12.5; H-E stain) revealed pleomorphic malignant cells and hemorrhagic necrosis (arrow).

  • Fig. 2 Ductal carcinoma in situ (DCIS). A. Sonography demonstrated multiple conglomerated oval masses within an eccentric cystic component (arrow). B. Photography (original maaagnification, × 40; H-E stain) revealed DCIS of the micropapillary type. The cystic lesions were lined by micropapillary cells and the lumen was filled with necrotic materials (arrow).

  • Fig. 3 Papillary carcinoma: aspiration yielded bloody fluid, and following excision biopsy, revealed a low-grade intraductal papillary carcinoma. A. Sonography scan showed a well-circumscribed, oval cystic mass with thick septa and an eccentric solid nodular component (arrow). A fluid-debris level was seen (arrowhead). B. Photography (original magnification, × 100; H-E stain) revealed a dilated duct filled with papillary carcinoma (arrow).

  • Fig. 4 Mucinous carcinoma. A. Sonography presented a lobulated, oval mass with an eccentric cystic component (arrow). B. Photography (original maaagnification, × 40; H-E stain) revealed malignant cells floating in pools of mucin. The tumor cells were present as small papillary clusters with pleomorphic features. The borders were relatively well circumscribed, and the mucinous pools often mimicked cysts (arrow).

  • Fig. 5 Medullary carcinoma. A. Sonography showed hypoechoic cystic lesions (arrow) with a smooth and well-circumscribed margined mass. B. Photography (original magnification, × 40; H-E stain) showed medullary carcinoma circumscribing lymphoid tissue with multifocal microcystic degenerations (arrow).

  • Fig. 6 Metaplastic carcinoma. A. Sonography demonstrated a microlobulated, oval mass with eccentric cystic components (arrow). B. Photography (original magnification, × 40; H-E stain) revealed a metaplastic carcinoma of the breast, which showed spindle and squamoid differentiation. The center of the lesion revealed cystic degeneration by necrosis (arrow).

  • Fig. 7 Malignant phyllodes tumor. A. Sonography showed a lobulated, oval mass with an eccentric cystic component (arrow). B. Photography (original magnification, × 40; H-E stain) revealed a biphasic tumor composed of cystic epithelial components (arrow) and cellular stroma with marked pleomorphism.


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