5.

Cysts Of The Mamma

It has been already pointed out that cysts frequently complicate other tumours, especially adeno-
fibromas or sarcomas, but sometimes cancers. Cysts also occur independently, and they too most
frequently originate from the gland structures.

Most cysts of the mamma belong to the group of Retention cysts, arising in consequence of
obstruction of the ducts. The cause of obstruction is sometimes an interstitial inflammation, and in that
case the cysts will usually be small and multiple, just as they are in the kidneys in interstitial nephritis.
In other cases the cause is obscure, and as the cysts may assume a large size the origin is perhaps
embryonic.

(1) Multiple cysts in old people (Involution cysts) occur in connection with involution of the gland. The
cysts are usually small, about the size of small shot or hemp-seed, but may be larger. When
unopened they have a greenish or blackish appearance, and they contain a glairy fluid in which fat
and epithelial cells are present.

(2) Simple cysts may grow to a large size, forming tense thin-walled sacs. They are usually single, but
if of small size they may be multiple. Their contents vary considerably, being usually serous or sero-
sanguineous, but sometimes they are deep brown in colour, and contain fat and cholestearine. In
some cases they contain milky fluid, in which case they would be called galactoceles.

(3) Galactoceles or Lacteal cysts arise usually when the gland is active. They are found chiefly in the
neighbourhood of the nipple, arising by dilatation of the larger ducts. They contain milk, usually like
ordinary milk, but sometimes altered so as to resemble cream or thickish oil, or curd, or butter. These
cysts are usually solitary, and are very rare.

(4) Connective tissue cysts have been recently described and are supposed to be of lymphatic origin.
They have thick walls and the connective tissue may be indurated around them. Hence they
resemblescirrhus in their clinical aspects. The internal surface is lined with a flat endothelium. The
cysts are single or multiple.

Parasites In The Mamma

The only parasite of any consequence is the Echinococcus which forms hydatid cysts. These may be
with difficulty discriminated from simple cysts, and as there is sometimes
considerable indurationaround them, they may also be mistaken for cancers.

The Cysticercus cellulosae has also been observed in the mamma (Gruermonprez).

Literature

Tumours - Astley Coopee, Illustr. of dis. of breast, 1829; Biekett, Dis. of breast, in Holmes' Surg., iv.,
1870; Veleeau, Treatise on dis. of breast (Syd. Soc. transl.), 1856; Billeoth, Die Krankh. der weibl.
Brustdrusen, 1880; Creighton, Phys. and path, of breast, 2nd ed., 1886; Gross, Treat, on Tumours
ofmammary gland, 1880, and article in Mann's Syst. of Gynecology, 1888; Beyant, Diseases of
breast, 1887; Bogee Williams, Dis. of breast, 1894. Eczema of nipple - Paget, St. Barth. Hosp. Bep.,
1874; Butlin, Med. chir. trans., lx. and lxiv.; Thin, Path, trans., xxxii., 1881, p. 218; Muneo, Glasg. Med.
Jour., xvi., 1881; Daeiee, Ann.;de Dermat., x., 1889; Wickham, Arch, de path, exper., ii., 1890; Boeck,
Arch. f. Dermat., xxiii., 1891; Peteesen, Centralb. f. Bakt., xiv., 1893; Hutchinson, Je., Path, trans., xli.,
1890, p. 214. Cysts - Gross and Beyant, 1. c. Parasites - Haussmann, Parasiten der Brustdriise,
1874; Guermonprez, Lyon med., 1883; Thomas, Hydatid disease, 1894, vol. ii.
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Definition
By Mayo Clinic staff

Fibrocystic breast changes

Breast cysts are fluid-filled sacs within your breast. You can have one or many breast cysts.
They're often described as round or oval lumps with distinct edges. In texture, a breast cyst
usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts are common in women in their 30s and 40s. If you have breast cysts, they usually
disappear after menopause, unless you're taking hormone therapy.

Breast cysts don't require treatment unless a cyst is large and painful or otherwise uncomfortable.
In that case, draining the fluid from a breast cyst can ease your symptoms.

Symptoms
By Mayo Clinic staff
Signs and symptoms of breast cysts include:

 A smooth, easily movable round or oval breast lump with distinct edges

 Breast pain or tenderness in the area of the breast lump

 Increase in breast lump size and breast tenderness just before your period

 Decrease in breast lump size and resolution of other signs and symptoms after your period

Having one or many simple breast cysts doesn't increase your risk of breast cancer.

When to see a doctor

Normal breast tissue in healthy women often feels lumpy or nodular. If you detect the presence of
any new breast lumps, however, or if a previously evaluated breast lump seems to have grown or
otherwise changed, make an appointment with your doctor to get it checked out

Causes
By Mayo Clinic staff
Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a
daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and
breast-feeding. Small ducts conduct the milk to a reservoir just beneath your nipple. Supporting
this network is a deeper layer of connective tissue called stroma.

Breast cysts develop when an overgrowth of glands and connective tissue (fibrocystic changes)
block milk ducts, causing them to dilate and fill with fluid.

 Microcysts are too small to feel but may be seen during imaging tests, such as
mammography or ultrasound.

 Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5
centimeters) in diameter. Large breast cysts can put pressure on nearby breast tissue,
causing breast pain or discomfort.
The cause of breast cysts remains unknown. Some evidence suggests that excess estrogen in your
body may play a role in breast cyst

Preparing for your appointment

By Mayo Clinic staff
For evaluation of a new breast lump or changes on your breast exam, you're likely to start by
seeing your primary health care provider. In some cases, based on a clinical breast examination or
findings on an imaging test, you may be referred to a breast health specialist.

What you can do

The initial evaluation focuses on your medical history. You'll discuss with your doctor the
symptoms you're experiencing, their relation to your menstrual cycle and any other relevant
information. To facilitate this discussion:

 Take note of all your symptoms, even if they seem unrelated to the reason for which
you scheduled the appointment.

 Review key personal information, including major stresses or recent life changes.

 Make a list of all medications, vitamins and supplements that you regularly take.

 Write down questions to ask your doctor. List your questions from most important to
least important in case time runs out.

What to expect from your doctor

Your doctor may ask you questions about:

 How long you've experienced symptoms

 If you've noticed a change in symptoms over time

 Whether you experience any breast pain and the severity of your pain

 Whether symptoms occur in one or both breasts

 When you had your last mammogram

 Your family history

 Your personal history of precancerous breast lesions

 If you've previously had a breast lump or breast biopsy

Tests and diagnosis

By Mayo Clinic staff
Screening and diagnosis of a breast cyst usually begins after you or your doctor has identified a
breast lump. The process may involve the following tests or exams:

 Clinical breast exam. Your doctor physically examines the breast lump and checks for
any other problem areas in your breasts. Questions to anticipate include when you first
noticed the lump, whether its size has changed, if you have any breast pain associated
with the breast lump, whether you have nipple discharge and how your menstrual cycle
affects the lump. However, your doctor can't tell from a clinical breast exam alone whether
 a breast lump is a cyst, so you'll need another test, either an imaging test or fine-needle
aspiration.

 Breast ultrasound. Breast ultrasound can help your doctor determine whether a breast
lump is fluid-filled or solid. The radiologist — a doctor trained to perform imaging exams
and procedures — performing the ultrasound makes this determination based on certain
characteristics seen during the imaging exam. A fluid-filled area usually indicates a breast
cyst. A solid-appearing mass most likely is a noncancerous lesion, such as a fibroadenoma,
but solid lesions could also be breast cancer. Based on what they see on the ultrasound,
your doctor and radiologist might recommend a biopsy to further evaluate a solid-
appearing mass.

If your doctor can easily feel a breast lump, he or she may skip breast ultrasound and perform
fine-needle aspiration instead.

 Fine-needle aspiration. During this procedure, your doctor inserts a thin needle into the
breast lump and attempts to withdraw (aspirate) fluid. If fluid comes out and the breast
lump goes away, your doctor can make a breast cyst diagnosis immediately.

Unless there appears to be blood in the fluid, it requires no further testing or treatment after
draining. If the fluid is bloody, a laboratory may need to test it. Lack of fluid or a breast lump that
doesn't disappear after aspiration suggests that the breast lump — or at least a portion of it — is
solid, and a sample of cells may be collected and sent for analysis to check for the presence of
cancer (fine-needle aspiration biopsy).

Treatments and drugs

By Mayo Clinic staff

Fine-needle aspiration

No treatment is necessary for simple breast cysts. Your doctor may recommend nothing more than
closely monitoring a breast cyst to see if it resolves on its own.

Fine-needle aspiration
Fine-needle aspiration, the procedure used to diagnose a breast cyst, also may serve as
treatment, if your doctor removes all the fluid from the cyst at the time of diagnosis, your breast
lump disappears and your symptoms resolve.

First, your doctor feels your breast to locate the cyst and hold it steady. Next, he or she inserts a
thin needle into the breast lump and withdraws (aspirates) the cyst fluid. Often, fine-needle
aspiration is done using ultrasound to guide accurate placement of the needle.

 If the fluid is nonbloody and the breast lump disappears, you need no further
treatment.

 If the fluid appears bloody or the breast lump doesn't disappear, your doctor may
send a sample of the fluid for laboratory testing and refer you to a breast surgeon or to a
radiologist for follow-up.

 If no fluid is withdrawn, your doctor will likely recommend an imaging test — such as
mammography or ultrasound — and possibly a biopsy to further evaluate the lump.

If you have breast cysts, you may need to have fluid drained more than once. Recurrent or new
cysts are common.
Hormone use
Using oral contraceptives to regulate your menstrual cycles may help reduce the recurrence of
breast cysts. Discontinuing hormone replacement therapy during the postmenopausal years may
reduce the formation of cysts as well.

Surgery
Surgical removal of a breast cyst is necessary only in a few unusual circumstances. If an
uncomfortable breast cyst recurs month after month, or if a breast cyst contains blood-tinged fluid
and displays other worrisome signs, surgery may be considered.

Lifestyle and home remediesTests and

Lifestyle and home remedies
By Mayo Clinic staff
To minimize discomfort associated with breast cysts, you might try these measures:

 Wear a supportive bra. If you have breast pain from a breast cyst, good support to
surrounding breast tissue may help relieve some discomfort.

 Avoid caffeine. There's no scientific proof that caffeine consumption is linked to breast
cysts. However, many women find relief from their symptoms after eliminating caffeine
from their diets. Consider reducing or eliminating caffeine — in beverages as well as in
foods such as chocolate — to see if your symptoms improve.

 Reduce salt in your diet. Although studies on salt restriction and cyst formation aren't
conclusive, some experts suggest that reducing salt in your diet may help. Consuming less
sodium reduces the amount of excess fluid retained by your body, which in turn may help
alleviate symptoms associated with a fluid-filled breast cyst.
 Font Size

Cyst Symptoms and Causes

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Medical Author: Melissa Conrad Stöppler, MD

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A cyst is a closed sac- or bladder-like structure that is not a normal part of the tissue where it is found. Cysts are comm
of any age. Sometimes they may be felt as an abnormal or new lump or bump anywhere in the body. Cysts usually co
Since cysts vary in size, they may be detectable only under a microscope or they can grow so large that they displace
cyst is called the capsule.

Cysts can arise through a variety of processes in the body, including

• "wear and tear" or simple obstructions to the flow of fluid,

• infections,
• tumors,
• chronic inflammatory conditions,
• genetic (inherited) conditions, and
• defects in developing organs in the embryo.

Sometimes you can feel a cyst yourself when you feel an abnormal "lump." For example, cysts of the skin or tissues b
mammary glands (breasts) also may be palpable (meaning that you can feel them when you examine the area with yo
kidneys or liver may not produce any symptoms or may not be detected by the affected individual. These cysts often a
ray, ultrasound, computerized tomography or CT scan, andmagnetic resonance imaging or MRI).

There are hundreds of types of cysts that can arise in the body. Some of the more well-known types of cysts are

• cysts in the breast which are part of benign proliferative ("fibrocystic") disease (fibrocystic breast disease),
• ovarian cysts,
• cysts within the thyroid gland,
• Baker cyst (popliteal cyst) behind the knee,
• ganglion cysts of the joints and tendons,
• cysts of the glands within the eyelid, termed chalazions, and
• sebaceous cysts of the small glands in the skin.

The majority of cysts are benign, but some may produce symptoms due to their size and/or location. Rarely, cysts can
serious infections. If you're concerned about any abnormal swelling or "lump," talk to your doctor. He or she can recom
the cause of the cyst.
Breast Cysts

• What are breast cysts?

• Do cysts lead to cancer?

• Do cysts need to be aspirated (drained)?

• Does cyst fluid need to be analyzed in the laboratory?

• What will happen if a cyst is left alone?

What are breast cysts?

Cysts are fluid-filled sacs that grow inside the breasts. These sacs form when normal milk glands in

the breast get bigger. A woman can have a single cyst or many cysts at a time. Breast cysts range

in size from smaller than a pea to larger than a ping pong ball.

Breast cysts are common, particularly in women age 40-60. Although larger cysts can sometimes

be felt as "lumps," many cysts cannot be felt by physical examination. Cysts that cannot be felt

may be found during a mammogram or ultrasound.

When a mammogram shows a possible cyst, a breast ultrasound is usually done. An ultrasound

shows whether the lump is a fluid-filled cyst or a solid lump. It also shows whether a cyst is a

"simple cyst" or "complex cyst." Breast ultrasound is the best way to identify and diagnose breast

cysts because it is accurate 95 to 100% of the time.

Back to top
Do cysts lead to cancer?

Almost all breast cysts identified as "simple cysts" by ultrasound are benign and never become

cancerous. It is estimated that one in 1,000 cysts contain a tumor (but they are usually benign).

These tumors can be identified by ultrasound in most cases. Women with cysts are not at greater

risk for cancer although this risk may be slightly higher if there is a family history of breast cancer

(mother, sister, or daughter).

Back to top
Do cysts need to be aspirated (drained)?

When a breast lump is found your doctor may use a simple and effective technique called needle

aspiration to find out what is in the lump. If the lump is a fluid-filled cyst, the needle can remove

the fluid which usually makes the lump disappear. If no fluid is found, the lump is not a cyst and

whatever material is aspirated is sent to the laboratory for analysis.

When a cyst is discovered by ultrasound, aspiration is not generally recommended unless the cyst

looks unusual on the ultrasound image. Aspiration may also be done if the patient wants to relieve
physical or emotional discomfort caused by the cyst. If the ultrasound shows that the cyst may

contain material other than fluid, the doctor may recommend aspirating the cyst. This is done

using ultrasound guidance to make sure the cyst is completely drained. Read about ultrasound-

guided breast cyst aspiration.

Back to top
Does cyst fluid need to be analyzed in the laboratory?

Normal benign cyst fluid is usually yellow, green or gray and does not need to be analyzed in a

laboratory. Studies of breast cyst fluid from thousands of women show that analysis of fluid is

important only when the color of the fluid suggests previous bleeding.

Back to top
What will happen if a cyst is left alone?

Breast cysts often change in size. Breast cysts can look different or disappear entirely on

mammograms from one year to the next. This is why we recommend diagnostic rather

than screening mammograms for our patients with "cystic breasts" and changing lumps.

Diagnostic mammograms allow the doctor to complete an ultrasound at the same appointment as

the mammogram to make sure the changes are actually due to cysts and not solid lumps.