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Case number:154
Age:56
Clinical presentation:Postmenopausal woman with average risk of breast cancer presented with a left breast lump noticed 3 years ago. Examination revealed a soft lump in the outer quadrant of the left breast.


Mammography:


Breast composition:ACR category b (there are scattered areas of fibroglandular density)
Mammography features:

 ‣ Location of the lesion:Left breast, upper outer quadrant at 1–2 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:5.5 × 5.0 × 3.6 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:


Ultrasound features: Left breast, outer quadrants at 2 o’clock, 8.5 cm from the nipple and at 1.8 cm skin depth

 ‣ Mass
   • Location:Left breast, outer quadrants at 2 o’clock, 8.5 cm from the nipple and at 1.8 cm skin depth
   • Number:1
   • Size:6.0 × 1.8 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:

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 outer
   • Localization technique:Palpation
   • Nature of aspirate:Fatty aspirate
 ‣ Cytological description:Smears show adipose tissue and dense fibrous tissue with occasional attached epithelial cells
 ‣ Reporting category:Benign
 ‣ Diagnosis:On correlating with CBE and imaging findings, consistent with hamartoma
 ‣ Comments:None


Case summary:

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

Learning points:


  • Breast hamartoma is an uncommon benign tumour of the breast. The incidence is < 1% of benign breast lesions. Screening mammography may detect some of the hamartomas that would otherwise remain clinically occult.

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