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Case number:	015
Age:	42
Clinical presentation:	Premenopausal woman with average risk of breast cancer presented with a right breast lump. Examination revealed a 5 cm lump in the right breast.

Mammography:

Breast composition:	ACR category b (there are scattered areas of fibroglandular density)
Mammography features:
‣ Location of the lesion:	Right breast, upper outer quadrant at 10 o’clock, anterior and middle thirds
‣ Mass:
• Number:	1
• Size:	9.0 × 8.5 × 5.5 cm
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ Calcifications:
• Typically benign:	None
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Ultrasound:

Ultrasound features: Right breast upper outer quadrant at 10 o’clock position
‣ Mass
• Location:	Right breast upper outer quadrant at 10 o’clock position
• Number:	1
• Size:	8.0 × 2.5 cm
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed
• Echo pattern:	Heteroechoic
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	Minimum internal vascularity
‣ Special cases:	None

BI-RADS:

BI-RADS Category: 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology

Cytology:

Cytology features:
‣ Type of sample:	FNAC
‣ Site of biopsy:
• Laterality:	Right
• Quadrant:	Upper outer
• Localization technique:	Palpation, rubbery consistency felt through the needle
• Nature of aspirate:	Whitish material
‣ Cytological description:	Cell-rich smear of elongated, branching fragments of ductal epithelium and numerous single bipolar nuclei in the background. Fragments of fibromyxoid stroma were seen in the background
‣ Reporting category:	Benign
‣ Diagnosis:	Fibroadenoma
‣ Comments:	None

Histopathology:

Lumpectomy

Histopathology features:
‣ Specimen type:	Lumpectomy
‣ Laterality:	Right
‣ Macroscopy:	Single whitish tissue piece (7.5 × 5.5 × 3.5 cm). On cut section shows firm whitish areas and mucoid areas
‣ Histological type:	Histological features of fibroadenoma with extensive sclerosis of stromal tissue. Some of the ducts are cystically dilated
‣ Histological grade:
‣ Mitosis:
‣ Maximum invasive tumour size:
‣ Lymph node status:
‣ Peritumoural lymphovascular invasion:
‣ DCIS/EIC:
‣ Margins:
‣ Pathological stage:
‣ Biomarkers:
‣ Comments:

Case summary:

Premenopausal woman presented with right breast lump. Diagnosed as fibroadenoma, BI-RADS 2 on imaging and as fibroadenoma on cytology and histopathology.

Learning points:

Fibroadenoma is the most common benign tumour of the breast, typically occurring in women aged 20–35 years. It increases in size during pregnancy and tends to regress with age.