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Atlas of breast cancer early detection

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Case number:036
Clinical presentation:Perimenopausal woman presented with left nipple discharge. She had an increased risk of developing breast cancer because of a family history of breast cancer. Examination did not reveal any lump or palpable lesion.


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

 ‣ Location of the lesion:Left breast, central portion of the breast, central zone, anterior third
 ‣ Mass:
   • Number:Multiple
   • Size:Largest 1.5 cm in greatest dimension
   • Shape:Irregular
   • Margins:Indistinct
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:Fine pleomorphic
   • Distribution:In mass
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:Present
 ‣ Associated features:Fine pleomorphic microcalcifications in mass


Ultrasound features: Left breast, central portion of the breast, intraductal multiple lesions

 ‣ Mass
   • Location:Left breast, central portion of the breast, intraductal multiple lesions
   • Number:Multiple intraductal
   • Size:Largest 1.8 cm in greatest dimension
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Indistinct
   • Echo pattern:Heterogeneous
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Internal vascularity, dilated duct
 ‣ Special cases:None


BI-RADS Category: 4B (moderate suspicion of malignancy)

Further assessment:

Further assessment advised: Referral for cytology


Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Left
   • Quadrant:
   • Localization technique:Palpation
   • Nature of aspirate:
 ‣ Cytological description:Smears reveal a haemorrhagic background with sheets of tightly cohesive ductal epithelial cells suggestive of a proliferative breast lesion. A few cells show a very mild nuclear atypia with karyomegaly and hyperchromasia
 ‣ Reporting category:Atypical, probably benign
 ‣ Diagnosis:Mild atypia, likely benign
 ‣ Comments:A histological evaluation may be more informative

Case summary:

Perimenopausal woman presented with left breast nipple discharge. Diagnosed as left breast subareolar solitary dilated duct with intraductal lesions, BI-RADS 4B on imaging, as mild nuclear atypia on cytology, and reported at higher centre as ADH on histopathology.

Learning points:

  • ADH is considered a high-risk lesion and when seen on core biopsy, it warrants excision.

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