Home / Training / Manuals / Atlas of breast cancer early detection / Cases

Atlas of breast cancer early detection

                                                                                                                         Go back to the list of case studies
                                                                                                                         Click on the pictures to magnify and display the legends
Case number:037
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with a left breast lump noticed 6 months ago. This was associated with pain at the site. Examination revealed a tender firm mobile lump less than a centimetre in diameter in the upper outer quadrant of the left breast.


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

 ‣ Location of the lesion:Left breast, upper outer quadrant at 3 o’clock, anterior and middle thirds
 ‣ Mass:
   • Number:1
   • Size:1.5 × 1.0 cm
   • Shape:Irregular
   • Margins:Microlobulated
   • 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 features: Left breast, upper outer quadrant at 3 o’clock

 ‣ Mass
   • Location:Left breast, upper outer quadrant at 3 o’clock
   • Number:1
   • Size:1.0 cm in greatest dimension
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Microlobulated
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Internal vascularity
 ‣ Special cases:None


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

Further assessment:

Further assessment advised: Referral for cytology and for excision biopsy


Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Left
   • Quadrant:Outer lower
   • Localization technique:Palpation, rubbery consistency felt through the needle
   • Nature of aspirate:whitish
 ‣ Cytological description:Cellular smear showing elongated, branching epithelial fragments of regularly arranged cohesive cells. Single, bare bipolar or oval nuclei are scattered in the background. Loose fibromyxoid stroma are also seen
 ‣ Reporting category:Benign
 ‣ Diagnosis:Fibroadenoma
 ‣ Comments:None



Histopathology features:

 ‣ Specimen type:Lumpectomy
 ‣ Laterality:Left
 ‣ Macroscopy:Lumpectomy specimen (9.0 × 7.0 × 3.0 cm) with skin flap. Cut surface shows a firm white area (1.2 × 1.0 × 0.5 cm), 1.0 cm from the inferior margin below the skin. Another whitish area (3.0 × 2.0 cm) is seen superomedially
 ‣ Histological type:Sections from lumpectomy specimen reveal histological features of a fibroadenoma having intracanalicular and pericanalicular patterns. A few ducts in the fibroadenoma show features of UDH. The overlying skin is unremarkable. The adjacent fibroadipose tissue shows foci of fibrosis
 ‣ Histological grade:
 ‣ Mitosis:
 ‣ Maximum invasive tumour size:
 ‣ Lymph node status:
 ‣ Peritumoural lymphovascular invasion:
 ‣ Margins:
 ‣ Pathological stage:
 ‣ Biomarkers:
 ‣ Comments:

Case summary:

Postmenopausal woman presented with left breast lump. Diagnosed as mass of suspicious morphology, BI-RADS 4B on imaging and as fibroadenoma left breast on cytology. Fibroadenoma showed foci of epithelial hyperplasia on histopathology.

Learning points:

  • Fibroadenoma can reveal atypical features on ultrasound suspicious of breast carcinoma, such as irregular shape, heteroechogenicity, microcalcifications within the mass, or posterior shadowing. Microlobulated margins are a feature of atypical fibroadenoma. These atypical appearances are caused by interdigitation of the surrounding parenchyma.

IARC, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France - Tel: +33 (0)4 72 73 84 85 - Fax: +33 (0)4 72 73 85 75
© IARC 2024 - All Rights Reserved.