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Atlas of breast cancer early detection

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Case number:165
Clinical presentation:Postmenopausal woman with average risk of breast cancer presented with a left breast lump and mastalgia noticed 1 week ago.


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

 ‣ Location of the lesion:Left breast, upper inner quadrant at 11 o’clock, posterior third
 ‣ Mass:
   • Number:1
   • Size:2.6 × 1.7 cm
   • Shape:Irregular
   • Margins:Indistinct
   • 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 features: Left breast, upper inner quadrant at 11 o’clock, 10.2 cm from the nipple and at 1.0 cm skin depth

 ‣ Mass
   • Location:Left breast, upper inner quadrant at 11 o’clock, 10.2 cm from the nipple and at 1.0 cm skin depth
   • Number:1
   • Size:2.0 × 1.0 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed, 2–3 lobulations present
   • Echo pattern:Heteroechoic with central anechoic component
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:None


BI-RADS Category: 2 (benign)

Further assessment:

Further assessment advised: Referral for cytology


Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Left
   • Quadrant:Upper inner
   • Localization technique:Palpation
   • Nature of aspirate:0.5 mL of thin greyish fluid
 ‣ Cytological description:Smears reveal foamy macrophages, a few multinucleated giant cells, numerous lymphocytes, and occasional ductal epithelial cells on a background of granular debris, fat droplets, and fragments of adipose tissue
 ‣ Reporting category:Benign
 ‣ Diagnosis:Consistent with fat necrosis
 ‣ Comments:None

Case summary:

Postmenopausal woman presented with a painful left breast lump. Diagnosed as fat necrosis, BI-RADS 2 on imaging and as benign fat necrosis on cytology.

Learning points:

  • Fat necrosis is a benign, non-suppurative inflammatory process of adipose tissue. It is important to diagnose fat necrosis because it can often mimic carcinoma of the breast.
  • The histological appearance of fat necrosis depends on the age of the lesion, progressing from inflammation to necrosis showing liquefied fat and finally to fibrosis.

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