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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.