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Atlas of breast cancer early detection

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Case number:116
Clinical presentation:Premenopausal woman with average risk of developing breast cancer presented with a breast lump. Examination revealed a mobile breast lump on the right side.


Ultrasound features: Right breast, outer quadrants at 9 o’clock

 ‣ Mass
   • Location:Right breast, outer quadrants at 9 o’clock
   • Number:1
   • Size:2.3 × 1.4 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed, smooth lobulations
   • Echo pattern:Hypoechoic
   • Posterior features:Posterior Enhancement
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:None


BI-RADS Category: 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology


Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Right
   • Quadrant:Outer central
   • Localization technique:Palpation
   • Nature of aspirate:Whitish
 ‣ Cytological description:Smears reveal many clusters of ductal epithelial cells with myoepithelial cells. A few papillary clusters with mild atypia are seen. There are many stromal and adipose tissue fragments. Background shows a few bare nuclei
 ‣ Reporting category:Benign
 ‣ Diagnosis:Benign proliferative breast lesion
 ‣ Comments:None


Lumpectomy specimen

Histopathology features:

 ‣ Specimen type:Lumpectomy specimen
 ‣ Laterality:Right
 ‣ Macroscopy:Lumpectomy specimen (8.5 × 7.5 × 3.0 cm) with skin flap (3.0 × 1.2 cm). On serial sectioning, three well-circumscribed greyish white areas are identified (2.5 × 2.0 × 2.0 cm, 1.7 × 1.5 × 1.0 cm, and 1.4 × 1.0 × 1.0 cm)
 ‣ Histological type:Multiple sections studied show circumscribed centrilobular areas of florid adenosis with myoepithelial proliferation and a few ducts with epithelial proliferation. The surrounding stroma is proliferative with a few lymphocytes. A few nodular foci show histology consistent with sclerosing adenosis. Microglandular adenosis and UDH is noted. A few ducts show features of ductal hyperplasia with atypia and flat epithelial atypia. There is surrounding fibrosis with dilated ducts and occasional ducts with apocrine metaplasia and columnar cell metaplasia
 ‣ Histological grade:
 ‣ Mitosis:
 ‣ Maximum invasive tumour size:
 ‣ Lymph node status:
 ‣ Peritumoural lymphovascular invasion:
 ‣ DCIS/EIC:Absent
 ‣ Margins:
 ‣ Pathological stage:
 ‣ Biomarkers:
 ‣ Comments:Proliferative breast disease with florid adenosis, sclerosing adenosis, UDH, microglandular adenosis, and foci of ADH. There is no evidence of in situ or invasive malignancy

Case summary:

Premenopausal woman presented with a right breast lump. Diagnosed as BI-RADS 2 on imaging and as benign proliferative breast disease on cytology and histopathology.

Learning points:

  • Sclerosing adenosis can mimic carcinoma mammographically and histologically. Distinguishing microscopic features are a rounded lobulocentric configuration on low magnification and the presence of a peripheral myoepithelial cell layer in the elongated and compressed proliferating tubules.

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