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Case number:168
Age:65
Clinical presentation:Postmenopausal woman with average risk of developing breast carcinoma presented for screening. CBE revealed a small nodule palpable in the lower quadrant of the left breast.


Mammography:


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:2017: Right breast, vascular calcification
 ‣ Mass:
   • Number:0
   • Size:
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:Vascular calcification
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:2017: Left breast, lower inner quadrant at 7 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:1.6 × 1.2 cm
   • Shape:Oval
   • Margins:Circumscribed with perilesional halo
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Coarse
   • Suspicious:None
   • Distribution:Macrocalcifications within the mass
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Calcifications


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:2017: Left breast, upper outer quadrant at 1–2 o’clock, middle third
 ‣ Mass:
   • Number:0
   • Size:
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:Suspicious calcifications
   • Distribution:Numerous calcifications, > 5 in number, seen grouped together, in less than 2 cm of breast tissue, regional distribution
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:2018: Follow-up mammogram shows stable calcifications in the upper outer quadrant of the left breast, Middle third, BI-RADS 2 (benign)
 ‣ Mass:
   • Number:0
   • Size:
   • Shape:None
   • Margins:
   • Density:
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:
 ‣ Architectural distortion:
 ‣ Asymmetry:
 ‣ Intramammary node:
 ‣ Skin lesion:
 ‣ Solitary dilated duct:
 ‣ Associated features:None

BI-RADS:

BI-RADS Category (2017): 3 (probably benign)
BI-RADS Category (at follow-up (2018)): 2 (benign)

Case summary:

Postmenopausal woman presented with left breast nodule. Diagnosed as involuting (partially calcified) fibroadenoma in the left breast, BI-RADS 2 on Imaging. Survey of bilateral breast mammogram reveals grouped calcifications of suspicious morphology in the left breast on initial assessment, BI-RADS 3. Regular annual follow-up reveals stable unchanged calcifications in the left breast, diagnosed as BI-RADS 2 on imaging.

Learning points:


  • Solitary group of round or punctate calcifications are BI-RADS 3 (probably benign).
  • Stability on follow-up confirms the benign nature of calcifications, which can be categorized as BI-RADS 2 (benign finding).

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