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Case number:139
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.


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 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 Category: 2 (benign)

Further assessment:

Further assessment advised: Referral for 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.

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