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Case number:084
Clinical presentation:Postmenopausal woman after surgery for right breast carcinoma. On postoperative surveillance, examination revealed a palpable right breast lump at the operated site.


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Right breast, upper inner quadrant at 1 o’clock, posterior third, beneath surgical scar
 ‣ Mass:
   • Number:1
   • Size:3.0 × 1.5 cm
   • Shape:Oval
   • Margins:Indistinct
   • Density:High
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:Present
 ‣ Asymmetry:Focal
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Skin retraction, architectural distortion, and trabecular thickening in postoperative breast


Ultrasound features: Right breast, upper inner quadrant, 1 o’clock position

 ‣ Mass
   • Location:Right breast, upper inner quadrant, 1 o’clock position
   • Number:1
   • Size:3.2 × 1.6 cm
   • Shape:Oval
   • Orientation:Not parallel
   • Margins:Indistinct
   • Echo pattern:Anechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:None
 ‣ Associated features:Postoperative fluid collection, architectural distortion, and absent vascularity
 ‣ Special cases:None


BI-RADS Category (Right BCS, post operative breast): 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology


Cytology features:

 ‣ Type of sample:FNAC (cystic lesion)
 ‣ Site of biopsy:
   • Laterality:Right
   • Quadrant:Upper inner
   • Localization technique:Palpation
   • Nature of aspirate:10 mL of yellowish fluid
 ‣ Cytological description:Smears do not show any ductal epithelial cells. Many histiocytes with abundant foamy cytoplasm are seen on a proteinaceous background. Inflammatory cells are not seen
 ‣ Reporting category:Benign
 ‣ Diagnosis:Consistent with seroma
 ‣ Comments:None

Case summary:

Postmenopausal woman after right breast-conserving surgery on postoperative surveillance presented with right breast lump at site of surgery. Diagnosed as organized seroma in right breast with surgical scar, BI-RADS 2 on imaging and as right breast seroma collection on cytology.

Learning points:

  • Diagnostic pitfall: When squamous metaplasia of the cells lining the seroma cavity occurs, smears may show atypical epithelial cells with high N:C ratios and hyperchromatic nuclei.

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