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Case number:157
Age:62
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with a hard palpable lump in the inner quadrant of the left breast.


Mammography:


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Left breast, lower inner quadrant at 8 o’clock, anterior and middle thirds
 ‣ Mass:
   • Number:1
   • Size:1.6 cm in greatest dimension
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:Popcorn-like
   • Suspicious:None
   • Distribution:Within mass
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Calcifications


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Left breast, inner quadrants at 9 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:0.9 cm in greatest dimension
   • Shape:Oval
   • Margins:Circumscribed
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Macrocalcifications
   • Suspicious:None
   • Distribution:Within mass
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Calcifications


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Right breast, lower inner quadrant at 5 o’clock, posterior third
 ‣ Mass:
   • Number:1
   • Size:0.6 cm in greatest dimension
   • Shape:Oval
   • Margins:Circumscribed
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:Coarse
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Calcifications

Ultrasound:


Ultrasound features: Left breast, lower inner quadrant at 9 o'clock

 ‣ Mass
   • Location:Left breast, lower inner quadrant at 9 o'clock
   • Number:1
   • Size:1.6 cm in greatest dimension
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic
   • Posterior features:Strong posterior shadowing
 ‣ Calcifications:Present
 ‣ Associated features:None
 ‣ Special cases:None


Ultrasound features: Left breast, inner quadrants at 8 o'clock

 ‣ Mass
   • Location:Left breast, inner quadrants at 8 o'clock
   • Number:1
   • Size:0.9 cm in greatest dimension
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:Present in mass
 ‣ Associated features:None
 ‣ Special cases:None

BI-RADS:

BI-RADS Category: 2 (benign)

Case summary:

Postmenopausal woman presented with a hard lump in the left breast. Diagnosed as involuting (partially calcified) fibroadenomas, BI-RADS 2 on imaging.

Learning points:


  • The mammographic appearance of typically benign-appearing popcorn-like calcification is the key evidence for management. The palpable mass is confidently labelled as benign and there is no need for further assessment.

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