The periportal space is a potential space surrounding the portal vein and its intrahepatic branches.

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DESCRIPTIONA 25-year-old man presented with a painless swelling in his left breast for 2 years. On palpation, the mass was soft and mobile. Mammography showed a high-density, circumscribed mass in the central breast ( figure 1). Ultrasound showed a mass with multiple clusters of parallel alternating echogenic and hypoechoic lines resembling tram-tracks (figure 2). Colour Doppler did not reveal any flow. Biopsy yielded white flaky material. Pathology revealed this to be keratin flakes suggestive of an Epidermal Inclusion Cyst (figure 3). This is an uncommon benign entity comprising of a cyst wall lined with stratified squamous epithelium and containing laminated keratin.It is commonly located in the skin layer of the breast, but may also occur deep in the breast parenchyma.Theories regarding the development of this cyst include traumatic implantation of epidermal fragments, squamous metaplasia in a dilated duct or inflammatory downgrowth of epidermis secondary to an obstructed hair follicle. 1These masses are well circumscribed, and isodense or of high density on mammography, with occasional benign calcifications. 2On ultrasound, the common appearance is a hypoechoic lesion with scattered echogenic foci while the most classical appearance is an onion ring appearance. The onion ring appearance comprises of alternating concentric hyperechoic and hypoechoic rings corresponding to lamellated keratin material. In our case, instead of the typical onion ring appearance, there were multiple parallel Asymptomatic, small and stable lesions do not require treatment. However, large or enlarging lesions have to be excised for cosmesis and to exclude an underlying malignancy. Learning points▸ An epidermal inclusion cyst is a dermal lesion in the breast.Diagnosis is relatively straightforward when the lesion is small, located in the dermis and associated with a history of trauma. ▸ However, in deep-seated lesions, ultrasound appearance of an epidermal inclusion cyst can be diagnostic and obviate the need for a biopsy.

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