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Case number:	132
Age:	50
Clinical presentation:	Perimenopausal woman with average risk of developing breast cancer presented with left breast pain and swelling.

Mammography:

Breast composition:	ACR category b (there are scattered areas of fibroglandular density)
Mammography features:
‣ Location of the lesion:	Left breast, upper quadrants, central zone at 12 o’clock, middle third
‣ Mass:
• Number:	0
• Size:	None
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	None
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	Present
‣ Asymmetry:	Focal
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	Architectural distortion

Ultrasound:

Ultrasound features: Left breast, upper quadrants at 12 o’clock, superior areolar margin
‣ Mass
• Location:	Left breast, upper quadrants at 12 o’clock, superior areolar margin
• Number:	1
• Size:	2.5 × 1.6 cm
• Shape:	Irregular
• Orientation:	Parallel
• Margins:	Indistinct
• Echo pattern:	Heterogeneous with areas of breakdown
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	Vascularity (vessels in rim)
‣ 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:	Left
• Quadrant:	Upper
• Localization technique:	Palpation
• Nature of aspirate:	0.2 mL of purulent material
‣ Cytological description:	Smears show many neutrophils on a necrotic background
‣ Reporting category:	Benign
‣ Diagnosis:	Acute inflammation
‣ Comments:	None

Case summary:

Perimenopausal woman presented with left breast pain and swelling. Diagnosed as inflammatory changes in left breast, BI-RADS 2 on imaging and as acute inflammation on cytology.

Learning points:

Most breast abscesses are treated without FNAC. Occasionally, when the clinical diagnosis is not obvious, the lesion is evaluated by FNAC. The cytological findings of breast abscess vary with the phase of inflammation (acute versus chronic).