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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.