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Atlas of breast cancer early detection

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Case number:009
Clinical presentation:Premenopausal woman with average risk of developing breast cancer presented with breast pain. She did not report a lump or nipple discharge. Examination revealed a 5 cm lump in the right breast.


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 10–12 o’clock, anterior, middle, and posterior thirds
 ‣ Mass:
   • Number:1
   • Size:6.5 × 3.5 × 3.0 cm
   • Shape:Irregular
   • Margins:Obscured
   • Density:High
 ‣ 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:Trabecular thickening


Ultrasound features: Right breast, upper outer quadrant at 8–10 o’clock

 ‣ Mass
   • Location:Right breast, upper outer quadrant at 8–10 o’clock
   • Number:1
   • Size:6.0 × 2.0 cm
   • Shape:Irregular
   • Orientation:Parallel
   • Margins:Indistinct
   • Echo pattern:Heterogeneous
   • Posterior features:Combined pattern
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:Clustered microcysts


BI-RADS Category: 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology


Cytology features:

 ‣ Type of sample:FNAC: 3 mL of greenish clear fluid was aspirated; swelling completely subsided after aspiration
 ‣ Site of biopsy:
   • Laterality:Right
   • Quadrant:Upper outer quadrant
   • Localization technique:
   • Nature of aspirate:3 mL of clear greenish fluid; swelling completely subsided after aspiration
 ‣ Cytological description:A few ductal epithelial cells, some with apocrine metaplasia seen with foamy histiocytes on a proteinaceous background
 ‣ Reporting category:Benign
 ‣ Diagnosis:Proliferative fibrocystic change
 ‣ Comments:None

Case summary:

Premenopausal woman presented with painful right breast lump. Diagnosed as fibrocystic change with clustered microcysts in right breast, BI-RADS 2 on imaging and as proliferative fibrocystic change on cytology.

Learning points:

  • Breast lumps are common in fibrocystic changes in the breasts. Ultrasound will reveal focal areas of thickening of the parenchyma, with or without patchy increase in echogenicity of the glandular tissue. A solitary cyst or clusters of small cysts may be seen. Focal fibrocystic changes may appear as solid masses or thin-walled cysts. Apocrine metaplasia is a very common fibrocystic change. The individual cells have abundant granular eosinophilic cytoplasm.

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