March 21, 2017, I encountered a 29-year-old lactating female with a left breast mass of about 3-4 cm. She noted the mass one month before giving birth (November 2017). An ultrasound was done in January 2017 which showed 2-cm solid nodule. A repeat ultrasound in March 2017 showed an increasing in size solid nodule (about 3-4 cm).
When I palpated the mass on the day of consultation, I felt the mass to be cystic meaning most likely the mass contained fluid as the mass was indentable on pressing. I told the patient the only way to resolve the difference between the ultrasound finding (solid) and my physical examination finding (cystic) was through a needle evaluation and aspiration. My primary diagnosis was a galactocoele (as I felt the mass to be cystic and the patient is lactating) and my secondary diagnosis is a fibroadenoma (if the ultrasound’s finding of solid nodule is correct).
Lo and behold, I was correct in my physical examination finding of cystic nature of the mass. I was able to aspirate 5 cc of very viscous milky substance with marked decrease in the size of the mass. I tried aspirating all the milky contents of the mass but was not able to because of the extreme viscosity of the fluid and the patient could not tolerate the procedure anymore. At any rate, with the needle evaluation and aspiration, my diagnosis was still a galactocoele with viscid to inspissated milky substances.
I used to think that ultrasound findings of all galactocoeles should be cystic nodules. With this recent experience, I learned that the ultrasound findings vary with fluidity of the galactocoeles. If it is very fluid, then cystic findings. If it is inspissated, most likely complex or even solid findings.
A new discovery for me. An information that I like to share with everybody, medical colleagues and patients.
Below are pictures to amplify the information that I am sharing.
Very inspissated galactocoele contents that will be reported as solid nodule on ultrasound and the mass needs to be excised.
Showing the thick capsule.
More fluid (sometimes very viscid) which may appear as cystic or solid on ultrasound depending on the fluidity of the milky contents. Most of the time, needle aspiration is both diagnostic and therapeutic (usually no need for excision operation).