Case number: | 105 |
Age: | 76 |
Clinical presentation: | Postmenopausal woman with increased risk of developing breast cancer because of family history of breast cancer presented for follow-up. Examination revealed a small palpable nodule in the retroareolar region of the right breast. |
Breast composition: | ACR category d (the breasts are extremely dense, which lowers the sensitivity of mammography) | Mammography features: |
‣ Location of the lesion: | 2000: Right breast, CC view |
‣ Mass: | |
• Number: | 0 |
• Size: | None |
• 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 |
Breast composition: | ACR category c (the breasts are heterogeneously dense, which may obscure small masses) | Mammography features: |
‣ Location of the lesion: | 2014: Right breast, central portion of the breast at 12 o’clock, middle third |
‣ Mass: | |
• Number: | 1 |
• Size: | 2.2 × 1.8 cm |
• Shape: | Oval |
• Margins: | Indistinct |
• Density: | Equal |
‣ Calcifications: | |
• 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 features: Right breast, central portion of the breast | |
‣ Mass | |
• Location: | Right breast, central portion of the breast |
• Number: | 1 |
• Size: | 1.0 × 0.7 cm |
• Shape: | Oval |
• Orientation: | Parallel |
• Margins: | Circumscribed |
• Echo pattern: | Complex cystic and solid |
• Posterior features: | No posterior features |
‣ Calcifications: | None |
‣ Associated features: | None |
‣ Special cases: | None |
Cytology features: | |
‣ Type of sample: | FNAC |
‣ Site of biopsy: | |
• Laterality: | Right |
• Quadrant: | Subareolar region at 12 o’clock |
• Localization technique: | Ultrasound-guided FNAC |
• Nature of aspirate: | Scant whitish fluid, < 0.2 mL |
‣ Cytological description: | Smears are sparsely cellular. A few three-dimensional clusters of ductal epithelial cells are seen. One cluster shows a papillary configuration. Nuclei are hyperchromatic and cytoplasm is scanty. Nucleoli are not seen. Many foamy macrophages are also seen and a few are haemosiderin-laden. Background shows thick proteinaceous material |
‣ Reporting category: | Atypical, probably benign |
‣ Diagnosis: | Suggestive of a papillary neoplasm, atypia seen, probably benign. Excision biopsy advised |
‣ Comments: | None |
Histopathology features: | |
‣ Specimen type: | Surgical excision |
‣ Laterality: | Right |
‣ Macroscopy: | Fibroadipose tissue (2.5 × 2.0 × 2.0 cm). On cut section a well-circumscribed cystic lesion (1.2 × 1.2 × 1.0 cm) showing papillary excrescences is seen |
‣ Histological type: | Breast papilloma |
‣ Histological grade: | |
‣ Mitosis: | |
‣ Maximum invasive tumour size: | |
‣ Lymph node status: | |
‣ Peritumoural lymphovascular invasion: | |
‣ DCIS/EIC: | |
‣ Margins: | |
‣ Pathological stage: | |
‣ Biomarkers: | |
‣ Comments: |
Postmenopausal woman with increased risk of developing breast cancer presented with a small palpable nodule in the retroareolar region of the right breast. Mammography and breast ultrasound dated 2014 reveal a new complex cystic mass with solid lesions along the walls of the cyst in the retroareolar region of the right breast. Compared with a previous mammogram dated 2000, follow-up reveals developing asymmetry in the right breast. Interval change is seen. Diagnosed as BI-RADS 4B on imaging, as papillary neoplasm, atypia seen, probably benign on cytology, and as breast papilloma on histopathology. |
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