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Case number:	084
Age:	71
Clinical presentation:	Postmenopausal woman after surgery for right breast carcinoma. On postoperative surveillance, examination revealed a palpable right breast lump at the operated site.

Mammography:

Breast composition:	ACR category a (the breasts are almost entirely fatty)
Mammography features:
‣ Location of the lesion:	Right breast, upper inner quadrant at 1 o’clock, posterior third, beneath surgical scar
‣ Mass:
• Number:	1
• Size:	3.0 × 1.5 cm
• Shape:	Oval
• Margins:	Indistinct
• Density:	High
‣ 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:	Skin retraction, architectural distortion, and trabecular thickening in postoperative breast

Ultrasound:

Ultrasound features: Right breast, upper inner quadrant, 1 o’clock position
‣ Mass
• Location:	Right breast, upper inner quadrant, 1 o’clock position
• Number:	1
• Size:	3.2 × 1.6 cm
• Shape:	Oval
• Orientation:	Not parallel
• Margins:	Indistinct
• Echo pattern:	Anechoic
• Posterior features:	Posterior shadowing
‣ Calcifications:	None
‣ Associated features:	Postoperative fluid collection, architectural distortion, and absent vascularity
‣ Special cases:	None

BI-RADS:

BI-RADS Category (Right BCS, post operative breast): 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology

Cytology:

Cytology features:
‣ Type of sample:	FNAC (cystic lesion)
‣ Site of biopsy:
• Laterality:	Right
• Quadrant:	Upper inner
• Localization technique:	Palpation
• Nature of aspirate:	10 mL of yellowish fluid
‣ Cytological description:	Smears do not show any ductal epithelial cells. Many histiocytes with abundant foamy cytoplasm are seen on a proteinaceous background. Inflammatory cells are not seen
‣ Reporting category:	Benign
‣ Diagnosis:	Consistent with seroma
‣ Comments:	None

Case summary:

Postmenopausal woman after right breast-conserving surgery on postoperative surveillance presented with right breast lump at site of surgery. Diagnosed as organized seroma in right breast with surgical scar, BI-RADS 2 on imaging and as right breast seroma collection on cytology.

Learning points:

Diagnostic pitfall: When squamous metaplasia of the cells lining the seroma cavity occurs, smears may show atypical epithelial cells with high N:C ratios and hyperchromatic nuclei.