Go back to the list of case studies
                                                                                                                         Click on the pictures to magnify and display the legends

Case number:	162
Age:	43
Clinical presentation:	Premenopausal woman with high risk of breast carcinoma because of family history (first-degree relative with bilateral breast carcinoma) presented with a right breast lump. CBE revealed a firm lump in the upper outer quadrant of the right breast.

Mammography:

Breast composition:	ACR category b (there are scattered areas of fibroglandular density)
Mammography features:
‣ Location of the lesion:	2011: Right breast, upper outer quadrant at 11 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	1.9 × 1.5 cm
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ 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

Mammography features:
‣ Location of the lesion:	2011: Left breast, upper inner quadrant at 11 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	1.0 cm in greatest dimension
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ 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

Breast composition:	ACR category b (there are scattered areas of fibroglandular density)
Mammography features:
‣ Location of the lesion:	2012: Right breast, upper outer quadrant at 11 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	1.9 × 1.5 cm
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ 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

Mammography features:
‣ Location of the lesion:	2012: Left breast, upper inner quadrant at 11 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	1.0 cm in greatest dimension
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ 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

Breast composition:	ACR category b (there are scattered areas of fibroglandular density)
Mammography features:
‣ Location of the lesion:	2017: Right breast, upper outer quadrant at 11 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	1.9 × 1.5 cm
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ 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

Mammography features:
‣ Location of the lesion:	2017: Left breast, upper inner quadrant at 11 o’clock, anterior third
‣ Mass:
• Number:	1
• Size:	1.0 cm in greatest dimension
• Shape:	Oval
• Margins:	Circumscribed
• Density:	Equal
‣ 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: 2011: Right breast, outer quadrants at 9 o’clock
‣ Mass
• Location:	2011: Right breast, outer quadrants at 9 o’clock
• Number:	1
• Size:	1.7 × 1.5 cm
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed, 2–3 lobulations present
• Echo pattern:	Heterogeneous
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

Ultrasound features: 2011: Left breast, upper inner quadrant at 11 o’clock
‣ Mass
• Location:	2011: Left breast, upper inner quadrant at 11 o’clock
• Number:	1
• Size:	1.0 × 10.5 cm
• Shape:	Irregular
• Orientation:	Parallel
• Margins:	Angular
• Echo pattern:	Hypoechoic
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

Ultrasound features: 2017: Right breast, outer quadrants at 9 o’clock
‣ Mass
• Location:	2017: Right breast, outer quadrants at 9 o’clock
• Number:	1
• Size:	1.7 × 1.5 cm
• Shape:	Oval
• Orientation:	Parallel
• Margins:	Circumscribed, 2–3 lobulations present
• Echo pattern:	Heterogeneous
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

Ultrasound features: 2017: Left breast, upper inner quadrant at 11 o’clock
‣ Mass
• Location:	2017: Left breast, upper inner quadrant at 11 o’clock
• Number:	1
• Size:	1.0 × 10.5 cm
• Shape:	Irregular
• Orientation:	Parallel
• Margins:	Angular
• Echo pattern:	Hypoechoic
• Posterior features:	No posterior features
‣ Calcifications:	None
‣ Associated features:	None
‣ Special cases:	None

BI-RADS:

BI-RADS Category (2011): 3 (probably benign)
BI-RADS Category (2012): 2 (benign)
BI-RADS Category (2017): 2 (benign)

MRI:

MRI features:
‣ MRI features:		Amount of fibroglandular tissue: ACR category a (predominantly fatty with small proportion of glandular density). Background parenchymal enhancement: Mild (25–50%), symmetrical
‣ Location:		Right breast at 11 o’clock
‣ Focus:		No
‣ Mass:
• Shape:	Round
• Margin:	Circumscribed
• Internal enhancement:	Homogeneous
• Kinetic curve:	Type I
‣ Non-mass enhancement:
• Distribution:	No
• Internal enhancement:	No
‣ Non-enhancing findings:		T2 hypointense
‣ Associated features:		A few smaller lesions of similar morphology
‣ Axillary nodes:		None

Case summary:

Premenopausal woman with increased risk of developing breast cancer presented with right breast lump diagnosed as involuting (partially calcified) fibroadenoma in right breast, BI-RADS category 2 on imaging. Left breast reveals probably benign lesion, BI-RADS category 3 on initial assessment. Regular annual follow-up done for 5 years and diagnosed as sclerotic fibroadenoma in left breast, BI-RADS category 2 on imaging.

Learning points:

The patient presented with a right breast lump and imaging revealed a clinically non-palpable left breast lesion. Initial assessment category is BI-RADS 3 (probably benign). Short-interval follow-up confirmed the lesions in both breasts to be stable. MRI breast was performed in view of the high-risk status at first annual follow-up. This revealed right breast fibroadenoma and left breast lesion probably sclerotic fibroadenoma. At 5 years follow-up the lesions are stable with features of involuting fibroadenoma. Final assessment category was BI-RADS 2 (benign) finding.