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Galactocele

A galactocele is the most common benign breast lesion (BIRADS II) that typically occurs in young lactating women; however they mostly occur on cessation of lactation 1. It is also sometimes referred to as a lactocele.

Clinical presentation

Patients typically present with a painless breast lump occurring over weeks to months. The lesion can present as a single or multiple nodule(s) and can be unilateral or bilateral.

Pathology

It is essentially a retention cyst resulting from lactiferous duct occlusion. Diagnosis can achieved with percutaneous aspiration 8. Biochemical analysis of material aspirated from galactoceles shows variety of proportions of proteins, fat, and lactose. Macroscopically, the milk within the galactocele may appear white and of usual viscosity if fresh, or thickened if the liquid is older.

Location

There may be predilection towards the sub-areolar region.

Radiographic features

Mammography

Mammographic appearance of galactocele can be varied depending on the fat and protein content and the consistency of the fluid. Based on these the galactoceles could appear like a 

Pseudolipoma

Due to significant fat content the mass appears radiolucent.

Fat fluid level within cyst

When fat and water is present and the milk is in fresh liquid state a characteristic fat fluid level is seen due to viscosity difference. This can be demonstrated on mediolateral view with the beam horizontal to the upright patient. 

Pseudohamartoma

Seen when contents are old milk and water. Due to highly viscous old milk significant separation of fat and water is not possible and hence gives a hamartoma like appearance on mammogram. 

Breast ultrasound

Ultrasound appearances can be widely variable. Sonographic characteristics according to one study is as follows 3

  • cystic / multicystic : ~ 50% 
  • mixed (cystic + solid) : ~ 37%
  • solid : ~ 13%

Colour Doppler interrogation will show a lack of blood flow.

Complications

Secondary infection with development of a breast abscess.

Additional work up 

In uncertain cases an aspiration is recommended in the first instance which will classically yield milky fluid 10.

Treatment and prognosis

They are benign lesions and spontaneous resolution occurs in a vast majority of cases. A small percentage have a residual collection that may mimic a fibroadenoma or complex cyst.

Etymology

The term galactocele derives from the Greek words galatea meaning milky white and cele meaning pouch 9.

Differential diagnosis

General considerations on imaging include

  • lactating adenoma - seen as a solid lesion and may show colour flow within it
  • breast abscess - has a different clinical presentation, but can develop as a complication.
  • fibroadenoma - classically ovoid or almond shaped with smooth border, internal homogeneous echogenicity and acoustic enhancement 7
  • carcinoma of the breast - especially for certain lesions on ultrasound

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