Cystic lymphangioma of the breast. First roentgen description.

Abstract

Cystic lesions of the breast, common findings in mammography, are almost always one of the manifestations of a mammary dysplasia such as mazoplasia cystica or secretory disease (1) . We recently had the opportunity to examine a patient with an unusual cystic lesion which turned out to be a cystic lymphangioma. The diagnosis was advanced on the basis of x-ray findings and was confirmed at operation. Case Report A 28-year-old Spanish woman was admitted to the Department of Surgery, Hopital cantonal, Lausanne, Switzerland, on Jan. 7, 1965, for excision biopsy of a cystic lesion of the right breast. A few months before admission the patient had noticed a small tumefaction below the right nipple, under the areola. She stated that the lesion had increased slightly in size but had remained soft. The patient showed it to her family physician during a visit for one of her children and was referred to this hospital. Physical examination revealed a healthy female with a normal left breast, but a slight prominence of the areola just below the nipple in the right breast. This soft tumefaction could be completely erased by pressure and reappeared when the whole breast was compressed. The most careful palpation revealed no tumors within the mammary gland itself. Mammography demonstrated a normal left breast for a woman of this age (Fig. 1). The right breast (Fig. 2) contained numerous rounded opacities, mostly in the inner quadrants, without associated fibrosis or change in the adjacent breast tissue. The palpable lesion was well shown just below the nipple, displacing it slightly upward. Its wall was in close contact with the skin of the areola, without any fatty tissue in between. The lack of associated fibrosis and connective tissue between this cyst and the skin struck us as unusual for cystic disease of the breast, so a diagnosis of cystic lymphangioma was made. Because the removal of the entire lesion would have meant the amputation of half the breast in a practically asymptomatic patient, we tried to confirm the diagnosis without a biopsy, thus avoiding the formation of a lymphatic fistula. A puncture of the area resulted in the removal of 50 ml of straw-colored fluid which coagulated. With the needle still in place, 50 cc of air was then injected, with the results demonstrated in Figure 3. This proved the communicating pattern of the cysts, suspected on clinical grounds. Only a few cells were in the aspirated fluid, and all were lymphocytes. This is very unusual for mammary cysts. The protein content was found to be 2.8 g/100 cc. Immunoelectrophoreses with an antihuman serum and antihuman maternal milk resulted in a picture resembling that of natural serum, diluted 2: 1. These two analyses seemed to go along nicely with the diagnosis of lymphangioma. The patient was readmitted on July 5, 1965, because of sudden painful swelling of the upper quadrant of the same breast. Palpation revealed a hard, bosselated, very tender mass, 7 cm in diameter.