The case of a 70-year-old female patient with family history of breast cancer come to the breast Unit for the presence of a nodular swelling in the right breast is discussed. On mammography and US a gross cystic neoformation with vascularized mural nodes was identified. Another contralateral solid nodular neoformation suggestive of malignancy was also present. Diagnostic completion with MRI confirmed the mixed solid, partly cystic nature of the right lesion, leading to the differential diagnosis with cystosarcoma phylloides and intracystic tumor. On the left side, MRI confirmed the presence of the second lesion whose morphologic and dynamic characteristics suggested a neoplastic lesion. At the anatomopathological examination the left lesion was shown to be an infiltrating ductal carcinoma; the right lesion was shown to be an intracystic tumor.