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Case number:	016
Age:	44
Clinical presentation:	Premenopausal woman with average risk of developing breast cancer presented with a left breast lump. She had had the lump for 4 years and recently noticed a gradual increase in its size on self-examination. CBE revealed a firm lump in the upper outer quadrant of the left breast, with clinical increase in the size of the left breast lesion.

Mammography:

Breast composition:	ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:
‣ Location of the lesion:	Left breast, upper outer quadrant at 1–2 o’clock, middle and posterior thirds
‣ Mass:
• Number:	1
• Size:	3.4 × 2.2 cm
• Shape:	Oval
• Margins:	Partly circumscribed and partly obscured
• Density:	Equal
‣ Calcifications:
• Typically benign:	None
• 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 outer quadrant at 2 o’clock
‣ Mass
• Location:	Left breast, upper outer quadrant at 2 o’clock
• Number:	1
• Size:	3.4 × 2.0 cm
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed
• Echo pattern:	Hypoechoic
• Posterior features:	No posterior features
‣ 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:	Left
• Quadrant:	Lower outer
• Localization technique:	Palpation
• Nature of aspirate:	Whitish
‣ Cytological description:	Cellular smears show cohesive sheets of ductal cells with finger-like shapes. Stromal fragments, some with a sharp, club-shaped or clover-leaf appearance, are present. Many bare nuclei are seen in the background
‣ Reporting category:	Benign
‣ Diagnosis:	Fibroadenoma
‣ Comments:	None

Histopathology:

Lumpectomy specimen

Histopathology features:
‣ Specimen type:	Lumpectomy specimen
‣ Laterality:	Left
‣ Macroscopy:	Specimen (7.0 × 6.0 × 6.0 cm) with a skin flap (4.0 × 1.0 cm). Cut surface shows a firm, bulging, whitish mass 3.2 cm in greatest dimension
‣ Histological type:	Fibroadenoma
‣ Histological grade:
‣ Mitosis:
‣ Maximum invasive tumour size:
‣ Lymph node status:
‣ Peritumoural lymphovascular invasion:
‣ DCIS/EIC:
‣ Margins:
‣ Pathological stage:
‣ Biomarkers:
‣ Comments:

Case summary:

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

Learning points:

The management of fibroadenoma is usually conservative. Follow-up is done to assess stability or regression. The regression of fibroadenoma is seen as calcification or hyalinization. An increase in the size of the fibroadenoma in perimenopausal women is an indication for excision.