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Case number:	008
Age:	41
Clinical presentation:	Premenopausal woman with average risk of breast cancer presented with a left breast lump. Examination revealed multiple small lumps in the left breast; the largest was 1.2 cm in diameter.

Mammography:

Breast composition:	ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:
‣ Location of the lesion:	Left breast, upper inner quadrant at 11 o’clock, middle and posterior thirds
‣ Mass:
• Number:	1
• Size:	2.0 × 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 c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:
‣ Location of the lesion:	Right breast, upper outer quadrant at 10 o’clock, middle third
‣ Mass:
• Number:	0
• Size:	No
• Shape:	None
• Margins:	None
• Density:	None
‣ Calcifications:
• Typically benign:	Typically benign, round
• 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, upper inner quadrant at 10 o’clock
‣ Mass
• Location:	Left breast, upper inner quadrant at 10 o’clock
• Number:	1
• Size:	1.8 × 1.0 cm
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed
• Echo pattern:	Heterogeneous
• Posterior features:	Posterior Enhancement
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	Complicated cyst

Ultrasound features: Left breast, central portion of the breast
‣ Mass
• Location:	Left breast, central portion of the breast
• Number:	1
• Size:	1.0 cm in greatest dimension
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed
• Echo pattern:	Anechoic
• Posterior features:	Posterior Enhancement
‣ 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 inner
• Localization technique:	Palpation
• Nature of aspirate:	0.5 mL of yellowish clear fluid
‣ Cytological description:	Plenty of foamy histiocytes and a few small clusters of benign ductal cells
‣ Reporting category:	Benign
‣ Diagnosis:	Fibrocystic change
‣ Comments:	None

Case summary:

Premenopausal woman presented with left breast lump. Diagnosed as complicated cyst in left breast with fibrocystic changes in both breasts, BI-RADS 2 on imaging and as benign fibrocystic change on cytology.

Learning points:

Fibrocystic changes are seen in perimenopausal women, commonly in their thirties and forties. The complicated cyst seen here is part of extensive fibrocystic changes. The appearance of the breast is heterogeneous and extremely variable depending on the stage and extent of morphological changes.