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Atlas of breast cancer early detection

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Case number:001
Age:50
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with a painless lump of duration 3–4 days in the upper outer quadrant of the left breast. On examination, she had a firm 3 cm lump in the upper outer quadrant of the left breast with minimal tenderness.


Mammography:


Breast composition:ACR category b (there are scattered areas of fibroglandular density)
Mammography features:

 ‣ Location of the lesion:Left breast, upper outer quadrant at 2 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:2.8 x 2.2 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: Left breast, central portion of the breast

 ‣ Mass
   • Location:Left breast, central portion of the breast
   • Number:Multiple
   • Size:Largest 3.0 × 2.0 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Anechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:Simple cyst


Ultrasound features: Right breast, central portion of the breast at 12 o’clock

 ‣ Mass
   • Location:Right breast, central portion of the breast at 12 o’clock
   • Number:Multiple
   • Size:Largest 0.7 cm in greatest dimension
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Anechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:Simple cyst

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 outer
   • Localization technique:Palpation
   • Nature of aspirate:5 mL of yellow turbid fluid
 ‣ Cytological description:Smears show large histiocytes (foam cells) with abundant vacuolated cytoplasm and an oval nucleus along with neutrophils on a proteinaceous background
 ‣ Reporting category:Benign
 ‣ Diagnosis:Non-proliferative fibrocystic change
 ‣ Comments:None


Case summary:

Postmenopausal woman presented with left breast lump. Diagnosed as simple cyst, BI-RADS 2 on imaging and as non-proliferative fibrocystic change on cytology.

Learning points:



  • Simple cyst is categorized as a special case in the BI-RADS ultrasound lexicon with a pathognomonic appearance.
  • Simple cyst in the breast is a component of fibrocystic change and usually occurs in women aged 30–50 years.


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