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Case number:	139
Age:	62
Clinical presentation:	Postmenopausal woman with average risk of breast cancer presented for the evaluation of a chest CT scan, which had detected a lump in the left breast. Patient first noticed a lump many years ago and reports that it has not increased in size.

Mammography:

Breast composition:	ACR category b (there are scattered areas of fibroglandular density)
Mammography features:
‣ Location of the lesion:	Left breast, upper inner quadrant at 11 o’clock, middle and posterior thirds
‣ Mass:
• Number:	1
• Size:	3.3 × 3.2 × 3.0 cm
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ Calcifications:
• Typically benign:	Macrocalcifications
• Suspicious:	None
• Distribution:	None
‣ Architectural distortion:	None
‣ Asymmetry:	None
‣ Intramammary node:	None
‣ Skin lesion:	None
‣ Solitary dilated duct:	None
‣ Associated features:	None

Ultrasound:

Ultrasound features: Left breast, upper inner quadrant at 11 o’clock
‣ Mass
• Location:	Left breast, upper inner quadrant at 11 o’clock
• Number:	1
• Size:	3.0 × 2.0 cm
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed
• Echo pattern:	Hypoechoic
• Posterior features:	No posterior features
‣ Calcifications:	Typically benign in mass
‣ Associated features:	Calcification in mass and poor vascularity
‣ 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:	Left
• Quadrant:	Upper inner
• Localization technique:	Palpation
• Nature of aspirate:	Whitish
‣ Cytological description:	Very cellular smears with tightly cohesive ductal epithelial cells. A few stromal fragments and bare nuclei are seen in the background
‣ Reporting category:	Benign
‣ Diagnosis:	Fibroadenoma
‣ Comments:	None

Case summary:

Postmenopausal woman presented with left breast lump. Diagnosed as fibroadenoma, BI-RADS 2 on imaging and as fibroadenoma on cytology.

Learning points:

The presence of typically benign macrocalcifications within the solitary breast mass are morphological features of an involuting fibroadenoma. Hyalinization, calcification, and/or ossification of the stroma are seen in older patients and can be appreciated radiographically.