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Atlas of breast cancer early detection

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Case number:007
Age:63
Clinical presentation:Postmenopausal woman with average risk of breast cancer presented with pain and lump in the left breast. Examination revealed a lump in the left retroareolar region.


Mammography:


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

 ‣ Location of the lesion:Left breast, lower inner quadrant at 6–7 o’clock, anterior third
 ‣ Mass:
   • Number:Multiple
   • Size:Largest 3.7 × 3.4 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


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, posterior third
 ‣ Mass:
   • Number:1
   • Size:2.3 × 2.2 cm
   • Shape:Round
   • Margins:Circumscribed
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Coarse, popcorn-like
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Calcifications


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

 ‣ Location of the lesion:Right breast, lower inner quadrant at 5 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:1.5 × 1.0 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


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

 ‣ Location of the lesion:Bilateral breasts, diffuse fat necrosis calcifications
 ‣ Mass:
   • Number:Multiple
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:Round
   • Suspicious:None
   • Distribution:Diffuse
 ‣ 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 at 6 o’clock

 ‣ Mass
   • Location:Left breast, central portion of the breast at 6 o’clock
   • Number:Multiple
   • Size:Largest 3.5 × 2.5 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, upper outer quadrant at 10 o’clock

 ‣ Mass
   • Location:Right breast, upper outer quadrant at 10 o’clock
   • Number:1
   • Size:1.8 × 1.3 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:Coarse macrocalcifications in mass
 ‣ Associated features:None
 ‣ 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:Lower inner
   • Localization technique:Palpation
   • Nature of aspirate:11 mL of straw-coloured fluid. Nodule was not palpable after the aspiration
 ‣ Cytological description:Smears show plenty of foamy histiocytes on a proteinaceous background. Ductal epithelial cells not seen
 ‣ Reporting category:Benign
 ‣ Diagnosis:Non-proliferative fibrocystic change
 ‣ Comments:None


Case summary:

Postmenopausal woman presented with painful left breast lump. Diagnosed as multiple simple cysts in the left breast, BI-RADS 2 on imaging and as non-proliferative fibrocystic change on cytology. Also noted were right breast involuting fibroadenoma and simple cyst, BI-RADS 2 on imaging.

Learning points:



  • A lump in the breast is a cause of great concern. High-frequency, high-resolution ultrasound helps in its evaluation. Diagnosis of a simple cyst (BI-RADS 2) is made because the following criteria are seen: sharply defined wall, enhanced through transmission of sound, no internal echoes, and lesions solitary or in groups.
  • Microscopically, the epithelial lining of many cysts, especially the larger ones, is flattened or absent, the cyst having only a thick fibrous wall. Frequently the cyst ruptures and elicits an inflammatory response in the stroma with abundant foamy macrophages and cholesterol clefts.


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