Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD – June 1, 2020
Question 1
A 60-year-old woman presents for a screening mammogram:
What is responsible for the appearance of this mammogram?
A. Extremely dense breast tissue with multiple oil cysts
B. History of silicone implant rupture
C. History of direct silicone injections
D. Steatocystoma multiplex
Answer
C. History of direct silicone injections
Explanation: Direct injection of silicone is a method of breast augmentation that is illegal in the United States, but may still be practiced in other countries. The practice results in a mammogram with multiple high density masses (with rim calcifications) and areas of greatly increased density. Extremely dense lymph nodes may also be present. These high-density silicone breast masses make it difficult to detect a breast cancer on both physical exam and mammography.
Steatocystoma multiplex is a skin disorder, manifesting in the breast as multiple bilateral subcutaneous oil cysts. Although this patient has multiple rim calcifications (which can also occur with oil cysts), steatocystoma multiplex would not explain the presence of so many areas of greatly increased density.