Giant galactocele in an adult female: a rare presentation and surgical management.

BACKGROUND

Galactocele, also known as lactocele, is a retention cyst resulting from lactiferous duct occlusion that typically occurs during lactation. Although a galactocele can occur anywhere along the milk line extending from the axilla to the groin, it has a propensity to form in the retroareolar region of the breasts. While small galactoceles are common, giant ones greater than 10 cm, especially in non-lactating women, are very rare and can mimic more ominous disease states on imaging.

CASE PRESENTATION: We present a case of a 34-year-old woman who stopped breastfeeding 5 years ago, and presented with a massive, painless, slowly enlarging breast mass over 1 year measuring 15 × 12 × 10 cm on ultrasound. Sonographic findings were initially suggestive of a complex cyst with a differential diagnosis of giant galactocele, abscess and cystic lymphangioma due to internal septations and a homogeneous low-level echo-complex demonstrating posterior acoustic enhancement. Ultrasound-guided aspiration was performed; however, due to the persistent massive size of the lesion and marked cosmetic deformity, the patient elected to undergo surgical excision.

DISCUSSION: Giant galactocele in adult females is rare and diagnostically challenging. Detailed lactation history, meticulous physical examination and ultrasound-guided aspirates are essential to avoid misdiagnosis and invasive procedures when benign pathology can be confirmed non-invasively. Ultrasound-guided aspiration is both a diagnostic and therapeutic tool in most patients, but surgery was done in our case.

CONCLUSION

A very large galactocele in a non-lactating woman may mimic other breast lesions due to its size, firmness, and imaging characteristics. Ultrasound-guided aspiration and histopathological confirmation remain essential to prevent misdiagnoses and over-treatment.