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Case number:	116
Age:	44
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:

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:

BI-RADS Category: 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology

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

Histopathology:

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.