Increasing Size of Cholesterol Granuloma of the Breast in the Vicinity of a Previous Breast Biopsy: Imaging Features and Review of the Literature

Abstract

BACKGROUND Cholesterol granuloma is a benign condition that can occur in the breast following trauma, breast biopsy, or surgical procedures. Cholesterol granuloma can mimic breast cancer on imaging studies. This report is of a case of an enlarging breast mass due to a repeat needle biopsy in the vicinity of a previous biopsy that resulted in a cholesterol granuloma that appeared to increase in size on ultrasound imaging. The mammographic and high-resolution sonographic imaging features of cholesterol granuloma of the breast are described, with a review of the literature of published cases of cholesterol granuloma of the breast diagnosed on imaging. CASE REPORT A 52-year-old woman had undergone multiple rounds of breast ultrasound scans for multiple breast nodules. At six-month follow-up with a needle biopsy was performed that showed benign cystic change. At 18-months follow-up high-resolution sonographic imaging showed a circumscribed, oval, hypoechoic mass with a benign morphology in the vicinity of the biopsy site. The size of the hypoechoic nodule increased progressively, and histopathology confirmed the diagnosis of a benign cholesterol granuloma. CONCLUSIONS This case demonstrated that cholesterol granuloma of the breast can increase in size after repeats adjacent breast biopsy, and may retain benign morphological features on ultrasound imaging, despite increasing in size.

Figure 1.

Initial ultrasound images of the right breast. (A, B) Initial transverse (A) and longitudinal (B) grayscale ultrasonograms of the right breast show a circumscribed, round, hypoechoic mass with no posterior features at the 12 o’clock position. (C) A color Doppler ultrasonogram demonstrates no vascularity within the mass.

Figure 2.

Ultrasound images of the right breast at six-month follow-up. (A) At six-month follow-up, a transverse grayscale ultrasonogram shows a new focal non-mass lesion at the 11 o’clock position of the right breast. (B) A color Doppler ultrasonogram demonstrates no internal vascularity within the non-mass lesion.

Figure 3.

Ultrasound images of the right breast at 18-months and 25-months after breast biopsy. (A–C) Successive grayscale ultrasonograms of the right breast prior to biopsy (A), and at 18 months (B), and at 25 months (C) after breast biopsy show a gradual increase in size in the longitudinal direction. Note the gradual changes from a round to an oval shape. (D) Color Doppler ultrasonogram at 25 months after biopsy shows no vascularity within the mass.

Figure 4.

Photomicrograph of the histology of the breast biopsy shows typical features of a cholesterol granuloma. Histology shows the typical features of a benign cholesterol granuloma with needle-shaped spaces where cholesterol crystals have been dissolved during tissue processing, surrounded by chronic inflammation, histiocytes, and macrophage giant cells. Hematoxylin and eosin (H&E). Magnification ×100.