Mammographic features of intracystic papillary lesions

In this article, the mammographic findings of ten patients with intracystic papillary lesions are reported. Two of these patients also had sonograms, which confirmed the presence of intracystic papillary fronds. Although not all intracystic lesions can be differentiated from gross cysts, there are several helpful roentgenologic and clinical clues. The tumor presents mammographically as a sharply circumscribed cystic mass with an irregular and sometimes nodular contour, except where tumor breaks through the wall of the cyst to invade the parenchyma. There the borders become shaggy. This tumor should be suspected clinically if a cystic lesion is seen in a postmenopausal woman not taking estrogens. Management depends on a high degree of suspicion, and a sonogram is useful to visualize the papillary fronds in the cysts. Although malignant papillary lesions are often large on presentation, they carry an excellent prognosis that is not related to their size. Treatment consists of either mastectomy or lumpectomy and radiation, with or without dissection of axillary nodes.