Epidermal inclusion cysts are benign cutaneous or subcutaneous lesions, which are filled with lamellated keratin and lined with stratified squamous epithelium. They are commonly found in the face, neck, trunk, and rare in the breast. Although most epidermal inclusion cysts are harmless, ruptured cysts can lead to infection or abscess and which often require surgical removal. Only few cases of ruptured epidermal cyst in breast have been reported, and furthermore, occurrence of ruptured epidermal cyst in the breast parenchyma is very rare. We now report a rare case of a ruptured epidermal inclusion cyst arising in the breast parenchyma.
Abscess* ; Breast* ; Epidermal Cyst ; Epithelium ; Neck

Epidermal cyst in the fibroadenoma of the breast is very rare. A 29-year-old woman presented with a lump in the upper outer quadrant of the right breast. Clinically it was a fibroadenoma and the excisional specimen showed an encapsulated, firm lobulated lesion with a cystic area on cut surface. The cystic area showed squamous metaplasia of the ductal epithelium and keratinous cyst formation in the fibroadenoma. We report this unusual case with review of literatures.
Adult ; Breast ; Epidermal Cyst* ; Epithelium ; Female ; Fibroadenoma* ; Humans ; Metaplasia

Epidermal inclusion cysts are formed by inclusion of keratinizing squamous epithelium within the dermis, resulting in a cyst filled with lamellated keratin. These benign cysts are usually very small and intradermal subcutaneous lesions. They can occur anywhere in the body although they are more common on the face, trunk, neck, extremities and scalp. Only a few cases of epidermal cysts of the breast have been reported in the literature. An epidermal inclusion cyst of the breast can result in several problems, even if the size is unusual. We encountered a case of a giant sized epidermal inclusion cyst of the breast initially mimicking a large fibroadenoma or phyllodes tumor.
Breast ; Breast Neoplasms ; Dermis ; Epidermal Cyst ; Epithelium ; Extremities ; Fibroadenoma ; Keratins ; Neck ; Phyllodes Tumor ; Scalp

OBJECTIVETo evaluate the incidences of hyperechoic breast lesions and hyperechoic breast cancers in lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 on ultrasound and investigate their sonographic features and the underlying histological causes.

METHODSThe pathologic records for 848 sonographically guided core needle biopsies or surgical resection were retrospectively reviewed from June 2012 to March 2014. Hyperechoic lesions were identified and their sonographic features were evaluated. The incidence of hyperechoic breast lesions and the frequency of hyperechoic cancers among all hyperechoic breast lesions were calculated.

RESULTSOf all 848 lesions, 0.9% (8/848) were hyperechoic. Twenty-five percent (2/8) of the hyperechoic lesions were malignant and the remaining six were benign. Among the 280 malignant lesions, 0.7%(2/280) were hyperechoic. The pathological basis of breast lesions presenting as hyperechoic nodules included inflammatory edema, galactoceles, and grit calcifications. Little difference of sonographic feature was found between benign and malignant hyperechoic lesions in this study.

CONCLUSIONSHyperechoic breast lesions are rare conditions but can be associated with a high ratio of breast cancer. History-taking and imaging techniques may help to avoid misdiagnosis.

PURPOSE: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US) techniques including tissue harmonic, compound, and the combination of these techniques. MATERIALS AND METHODS: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman's test and receiver operating characteristic (ROC) analyses. RESULTS: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). CONCLUSION: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.
Breast ; Breast Cyst ; Follow-Up Studies ; Humans ; Prospective Studies ; ROC Curve

PURPOSE: The purpose of this study was to evaluate the usefulness of sonographic BI-RADS in differentiation between benignity and malignancy of complex breast cysts. MATERIALS AND METHODS: Among 855 female patients who underwent ultrasound-guided core needle biopsy at our hospital from March 2012 through August 2012, 82 pathologically proven complex cysts detected on ultrasonography were included. The BI-RADS classification was made by radiologists prospectively and the imaging characterization of cystic lesions were classified retrospectively as cystic masses with a thick septa or thick wall, mixed solid and cystic masses, or solid masses with eccentric cystic foci. All lesions examined by ultrasonography were classified prospectively according to the BI-RADS lexicon. The pathologic findings were compared with sonographic appearance. We reviewed and compared the radiologic features between malignant lesions and benign lesions. RESULTS: Finally, according to biopsy results, there were 71 benign and 11 (13.4%) malignant lesions. The frequency of malignancy was significantly higher in solid masses with eccentric cystic foci (p value <0.025). The size of sonographic lesions was significantly larger in malignant lesions than in benign lesions (41.82 mm+/-34.36 vs 18.41 mm+/-16.8 respectively, p=0.049). No statistically significant difference was observed in the sonographic findings according to the BI-RADS lexicon, however, statistically significant difference in final assessment categories was observed between benign and malignant lesions (p value <0.001). CONCLUSIONS: The malignancy rate was higher in cystic lesions with predominantly solid masses and classified as suspicious malignancy using the BI-RADS lexicon.
Biopsy ; Biopsy, Large-Core Needle ; Breast Cyst ; Breast* ; Classification ; Female ; Humans ; Information Systems* ; Prospective Studies ; Retrospective Studies ; Ultrasonography*

The primary squamous cell carcinoma of the breast is an extremely rare neoplasm. The pathogenesis of the squamous cell carcinoma of the breast is puzzling because epithelial elements are not normally identified in breast tissue. It has been suggested that epithelial cells are derived from epidermoid cysts deposited during early embryological development, from metaplastic transformation of ductal cells, or after trauma or surgical manipulation. It must be carefully separated from lesions involving the epidermis and/or nipple region which must be considered as squamous carcinoma of the skin or dermal appendages. Also, it must be regarded as a separate entity distinct from adenocarcinoma of the breast with squamous cell metaplasia. We experienced a case of the primary squamous cell carcinoma and reported with a review the related literature briefly.
Adenocarcinoma ; Breast* ; Carcinoma, Squamous Cell* ; Epidermal Cyst ; Epidermis ; Epithelial Cells ; Metaplasia ; Nipples ; Skin

PURPOSE: Small breast cysts, which can be resolved by fine-needle aspiration, are often presented as hypoechoic masses on ultrasound examinations. They can be misinterpreted as benign tumors and cause unnecessary follow-ups or biopsies. The aim of this study was to find out the proportion of atypical breast cysts, which can be resolved by needle aspiration, among hypoechoic masses less than 1 cm in size and to investigate the relationship between the characteristics of a mass and its probability of being cystic. METHODS: Between March 2003 and May 2003, we found and aspirated 119 hypoechoic masses less than 1 cm in size from 104 consecutive patients. RESULTS: Mass size ranged from 2.5 mm to 9.8 mm, with a median size of 5.5 mm. Among the 119 hypoechoic masses, 40 masses (33.6%) were cystic and 79 masses (66.4%) were solid. Among the 40 cystic masses, 37 were completely resolved by needle aspiration, one mass was reduced to half, and the 2 remaining masses were reduced to a third of their sizes. In patients in their 20's, 11.1% of the hypoechoic masses were cystic masses, the ratios for patients in their 30's, 40's, 50's, and 60's were 11.4%, 32.0%, 76.2%, and 75%, respectively (P<0.001). With decreasing internal echo of mass, the likelihood of being a cyst increased (P=0.026). However predicting the probability of being a cyst by the margin, the degree of posterior acoustic enhancement, and the location of the mass was difficult (P>0.05). CONCLUSION: Needle aspiration must be considered in small hypoechoic masses not speculated as definite solid masses.
Acoustics ; Biopsy ; Biopsy, Fine-Needle* ; Breast Cyst ; Follow-Up Studies ; Humans ; Needles ; Ultrasonography ; Ultrasonography, Mammary

Epidermal inclusion cyst of the breast is an uncommon benign lesion and it is usually located in the skin layer. We report here on two cases of ruptured epidermal inclusion cysts in the subareolar area, which is a very unusual location for these cysts and these lesions can be mistaken for breast malignancies.
Adult ; Breast Diseases/surgery/*ultrasonography ; Epidermal Cyst/surgery/*ultrasonography ; Female ; Humans ; Middle Aged ; Rupture/ultrasonography

Breast cystic hypersecretory duct carcinomas (CHDC), characterized by cystic dilatation of ducts, cysts filled with thyroid colloid-like eosinophilic material, and by micropapillary carcinomas in the epithelium lining the cyst, is a rare histological variant of intraductal carcinomas. CHDC is differentiated from cystic hypersecretory hyperplasia. It's clinical manifestations are similar to those of other intraductal carcinomas. CHDC has a low-grade behavior for many years, but can be invasive, with the potential for metastasis. The importance of CHDC is its differentiation from a variety of other lesions of the breast, both benign and malignant. Various differential diagnoses for CHDC include: fibrocystic changes of the breast with microcyst formation, juvenile papillomatosis, benign mucocele-like lesions, juvenile secretory carcinomas, mucin-producing colloid carcinomas and metastatic follicular thyroid carcinomas. Histochemical staining (PAS, alcian blue and mucicarmine) or immunoperoxidase studies (CEA, alpha-lactalbumin and thyroglobulin) may also helpful in differential diagnoses. We report a case of a cystic hypersecretory duct carcinoma (CHDC) of the breast, and present a review of the literature.
Adenocarcinoma, Follicular ; Adenocarcinoma, Mucinous ; Alcian Blue ; Breast Cyst ; Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis, Differential ; Dilatation ; Eosinophils ; Epithelium ; Hyperplasia ; Lactalbumin ; Neoplasm Metastasis ; Papilloma ; Thyroid Gland