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Concentric Rings Within a Breast Mass on Sonography: Lamellated Keratin in an Epidermal Inclusion Cyst

Pavel Crystal1 and Ruthy Shaco-Levy2

1 Department of Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84105, Israel.
2 Department of Pathology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negeva, Beer-Sheva 84105, Israel.



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  		Fig. 1A. —65-year-old woman with epidermal inclusion cyst of left breast. Craniocaudal mammogram reveals oval, smoothly outlined mass (arrow).

 


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  		Fig. 1B. —65-year-old woman with epidermal inclusion cyst of left breast. Sonography shows solid, heterogeneously hypoechoic mass with alternating hypoechoic and hyperechoic concentric rings that look like onion rings.

 


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  		Fig. 1C. —65-year-old woman with epidermal inclusion cyst of left breast. Postfire sonogram after sonography-guided core biopsy shows echogenic 14-gauge needle has traversed lesion. Alternating hyperechoic and hypoechoic rings are visualized in mass.

 


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  		Fig. 1D. —65-year-old woman with epidermal inclusion cyst of left breast. On photomicrograph, lesion is lined by epidermal-type epithelium (arrowhead) and contains abundant lamellated keratin (arrows) pathognomonic for epidermal inclusion cyst. (H and E x200)

 

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