Galactocele

Teddy Jinnteh Su, MD - Case Coordinator
Donnella Green, MD - Radiology Discussion
Kirstine Yung-Ting Oh, MD - Pathology Discussion
Sughra Raza, MD - Attending Radiologist
Pablo R Ros, MD - Attending Radiologist

September 23, 2002

Presentation

Imaging Findings

Mammography demonstrates a mass in the upper, outer quadrant of the left breast. There are no calcifications or definite areas containing fat. An ultrasound image of the same lesion demonstrates a well-defined, primarily hypoechoic mass with a small eccentric hyperechoic area. The lesion is wider than it is long and seems to be confined to a single fascial plane. There is a slight increase in posterior acoustic enhancement.

Diagnosis

Discussion

Core needle biopsy shows areas of necrosis and inflammation. Both acute and chronic inflammatory changes are present. At higher power, granulation tissue is visible. Marked lactational change within the ducts is also evident. No evidence of malignancy is seen.

Radiology Discussion:

In mammography, a breast mass is defined as a space-occupying lesion that is seen in two different projections. If the lesion is visible in only a single projection, it is called a density. The lesion’s shape should be described (e.g., round, oval, lobular, irregular, other), as well as the margins (e.g., circumscribed, microlobulated, obscured, indistinct, spiculated) and density (e.g., high density, equal density, low density, fat containing).

A differential diagnosis can then be determined after characterization of the mass.

Taking into account the patient's postpartum history, this lesion may be related to breastfeeding. However, no definite areas of fat are seen on the mammogram to confirm a galactocele. There is a small hyperechoic region which could represent fat on ultrasound, but this is not definitive. These images suggest abscess, breast cancer, fibroadenoma or galactocele.

For a lucent mass, the differential diagnosis includes oil cyst (which may occur following hematoma or biopsy), lipoma, or galactocele (associated with lactation). For a mass of mixed density, fibroadenolipoma, galactocele, intramammary lymph node, and hamartoma should be considered. Breast cancers typically do not contain fat, but may trap fat; therefore, breast cancer should not be discounted if a lesion has areas of radiolucency.

Galactoceles most likely arise from obstructed milk ducts and occur during or soon after the cessation of breastfeeding. They may be radiographically indistinguishable from other fat-containing lesions. They can, however, have a mottled "curdled milk" appearance. Fat fluid levels may be visible in upright lateral mammograms.

References

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