Cyst of Montgomery: An uncommon adolescent breast lump

Abstract

Reports of the incidence of the cyst of Montgomery, a rare condition of the breast, affecting mainly adolescent female, are scarce in the literature. This cyst develops from an obstruction of the small papular projections at the edge of the areola called Montgomery tubercles. It could be a simple asymptomatic mass or an inflamed symptomatic mass. We report two cases encountered this year. The first case was a 15-year-old female who complained of bilateral breast pain and a right breast mass. Laboratory tests were unremarkable. A diagnosis of noninflamed Montgomery cyst based on clinical and sonographic examination was made. An antibiotic was recommended. The second case was a 13-year-old female who complained of pain and swelling with redness in the right breast. Laboratory tests were unremarkable. Sonographic examination revealed a right retroareolar cyst containing turbid echogenicity with surrounded hyperemia. A diagnosis of inflamed Montgomery's cyst was made. Medical treatment was successful without any surgical intervention. Both patients had favorable outcomes at follow-up visits. This stresses the importance of a proper recognition of the pathology, incidence, diagnosis and management of the cyst of Montgomery in the pediatric age group.

Homogeneous blue lumps of the nipple‐areola complex in pubertal girls

“…11 Retroareolar cyst is an underreported condition in female adolescents. 12 It is caused by the obstruction and consequent dilation of Montgomery's tubercle, a sebaceous gland closely connected to the terminal segment of a lactiferous duct. 13 An uninfected cyst runs an asymptomatic course, presenting as solitary or multiple, round to oval-shaped, well-defined anechoic masses, with a variable diameter of 2-20 mm, devoid of internal vascularity on color Doppler.…”

“…11 When retroareolar cyst is infected, US may show internal debris that swirl under gentle compression, septations, or fluid-to-fluid levels; PDUS detects increased vascular flow at lesion borders. 12,15 In that case, a seven-day course of oral antibiotics against Staphylococcus aureus is advisable. 16 Several hypotheses have been postulated on their etiology, which remains strictly related to breast development.…”

Prepubertal retroareolar cysts

“…The diagnosis is made by the clinical and ultrasonographic features, and ultrasonography being the gold standard diagnostic procedure 1,4 . Ultrasonography shows well‐defined oval anechoic lesions in the dermis and subcutis, with posterior enhancement and acoustic lateral shadows 1 . Some lesions may present moving echoes—the “snowfall sign”— probably due to their heterogeneous content 5 .…”

“…Septae can be seen in some lesions and peripheral vascular enhancement in the inflammatory ones 1 . Biopsy is not indicated because of the favorable prognosis and the risk of complications or scarring 1,3 . Only one report described nonspecific inflammatory reaction on biopsy specimens from three patients 3 …”

“…A favorable outcome with spontaneous involution is the rule in retroareolar cysts; non‐steroidal anti‐inflammatory agents are indicated for pain, and antibiotics can be prescribed if there are signs of infection 1,4 . Given the benign natural history of retroareolar cysts, aggressive diagnostic or therapeutic interventions should be avoided 1,3,4 …”