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Atlas of breast cancer early detection

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Case number:153
Clinical presentation:Postmenopausal woman with average risk of breast cancer presented with a right breast lump noticed 2–3 years earlier. Examination revealed a right breast lump (3 × 2 cm).


Breast composition:ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:

 ‣ Location of the lesion:Right breast, inner quadrants at 3 o’clock, middle and posterior thirds
 ‣ Mass:
   • Number:1
   • Size:3.2 × 2.7 cm
   • Shape:Oval
   • Margins:Circumscribed
   • Density:Fat-containing
 ‣ 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 features: Right breast, inner quadrants at 3 o’clock, 7.0 cm from the nipple and at 1.5 cm skin depth

 ‣ Mass
   • Location:Right breast, inner quadrants at 3 o’clock, 7.0 cm from the nipple and at 1.5 cm skin depth
   • Number:1
   • Size:4.0 × 1.5 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Heterogeneous
   • Posterior features:No posterior features
 ‣ 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:Inner
   • Localization technique:Palpation
   • Nature of aspirate:Fatty aspirate
 ‣ Cytological description:Cytological smears showed many adipose tissue fragments. A few ductal myoepithelial cells and isolated naked nuclei were seen
 ‣ Reporting category:Benign
 ‣ Diagnosis:On correlating with CBE and imaging findings, consistent with hamartoma
 ‣ Comments:None

Case summary:

Postmenopausal woman presented with right breast lump. Diagnosed as hamartoma (fibroadenolipoma) BI-RADS 2 on imaging and as hamartoma on cytology.

Learning points:

  • Hamartoma is also called adenolipoma, lipofibroadenoma, or fibroadenolipoma to describe the dominant tissue within the benign lesion in the breast. Predominantly fatty lesions may remain non-palpable and clinically occult. Lesions with predominantly fibrous components present as clinically palpable firm masses, may mimic morphological features of fibroadenoma or circumscribed carcinoma, such as mucinous or medullary histological variants of breast carcinoma. Triple assessment of a clinically palpable lump will be needed to confirm the diagnosis.

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