Cysts

Epidemiology and aetiology:

• Occurrence is usually after 35 years of age and up to the menopause
• There has been some suggestion that multiple recurrent cysts are associated with an increased tendency to breast cancer

Clinical features:

• The history is of a palpable and occasionally tender lump
• Physical findings are of a tense, discrete, mobile lump anywhere in the breast

Investigation and management:

Whenever a clinical diagnosis is made of a cyst, needle aspiration should be done at once:

• It yields straw-coloured fluid and causes collapse of the cyst
• Equally important, it immediately reassures the patient, although there have to be some exceptions:
• Failure of the lump completely to disappear
• Bloodstained aspirate

Failure to disappear completely:

• Re-evaluation must take place within a few weeks
• A persistent lump must be evaluated by mammography and either be subject to FNAC or excised for histological examination

Bloodstained aspirate:

• The simple cause is traumatic aspiration
• However, this must be confirmed by cytological examination of the aspirate and mammography
• Clinical reassessment, re-aspiration if a lump is present or excision biopsy is then the appropriate course

Multiple cysts:

• Some patients have multiple cysts identified at mammography or which present clinically as a lumpy breast
• Danazol can be helpful in reducing the incidence of clinical recurrence
• Given the possible risk of carcinoma, follow-up with mammography is necessary