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Case number:158
Age:74
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with a hard palpable lump in the outer quadrant of the left breast. The lump had been present for 15 years but recently it had developed a hard stony texture.


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 3 o’clock, 4.0 cm from the nipple, anterior and middle thirds
 ‣ Mass:
   • Number:1
   • Size:2.5 × 1.8 cm
   • Shape:Oval
   • Margins:Circumscribed
   • Density:Equal with dense calcifications
 ‣ 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 c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:

 ‣ Location of the lesion:Left breast, upper outer quadrant at 2 o’clock, 6.0 cm from the nipple, anterior and middle thirds
 ‣ Mass:
   • Number:1
   • Size:1.6 × 1.0 cm
   • Shape:Oval
   • Margins:Circumscribed
   • Density:Equal with dense macrocalcification
 ‣ 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 c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:

 ‣ Location of the lesion:Left breast, inner quadrant, anterior and middle thirds
 ‣ Mass:
   • Number:1
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:Round
   • Suspicious:None
   • Distribution:Diffuse
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None


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

 ‣ Location of the lesion:Right breast, inner and outer quadrants
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ Calcifications:
   • Typically benign:Coarse, round, and vessel calcification
   • 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, outer quadrants at 3 o’clock

 ‣ Mass
   • Location:Left breast, outer quadrants at 3 o’clock
   • Number:1
   • Size:3.1 × 1.8 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic with dense macrocalcification
   • Posterior features:Strong posterior shadowing
 ‣ Calcifications:Present in mass
 ‣ Associated features:None
 ‣ Special cases:None


Ultrasound features: Left breast, outer quadrants at 2 o'clock

 ‣ Mass
   • Location:Left breast, outer quadrants at 2 o'clock
   • Number:1
   • Size:1.6 × 1.0 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Hypoechoic with dense macrocalcification
   • 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 stony hard lump in the left breast. Diagnosed as involuting (partially calcified) fibroadenomas, BI-RADS 2 on imaging.

Learning points:


  • Fibroadenomas show changes of involution in the form of macrocalcifications in the mass with advancing age.
  • The mammographic appearance of typically benign coarse and popcorn-like calcifications is the key to further management. There is no further assessment for the mammographically labelled benign involuting fibroadenoma.

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