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Atlas of breast cancer early detection

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Case number:171
Age:38
Clinical presentation:Premenopausal woman with average risk of developing breast cancer presented with a painful right breast lump noticed a few days ago. On examination, a mobile palpable lump (3 × 2 cm) with smooth margins was noted in the inferior quadrant of the right breast below the areolar margin.


Mammography:


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

 ‣ Location of the lesion:Right breast, lower inner quadrant at 5 o’clock, subareolar region, anterior third, 0.1 cm from the nipple and at 0.2 cm skin depth
 ‣ Mass:
   • Number:1
   • Size:3.5 × 2.5 cm
   • Shape:Oval
   • Margins:Circumscribed with perilesional halo
   • 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: Right breast, lower inner quadrant at 5 o’clock, subareolar region, 0.1 cm from the nipple and at 0.2 cm skin depth

 ‣ Mass
   • Location:Right breast, lower inner quadrant at 5 o’clock, subareolar region, 0.1 cm from the nipple and at 0.2 cm skin depth
   • Number:1
   • Size:3.3 × 1.6 cm
   • Shape:Oval
   • Orientation:Parallel
   • Margins:Circumscribed
   • Echo pattern:Anechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:None
 ‣ Special cases:Fat necrosis

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:Subareolar lump
   • Localization technique:Palpation
   • Nature of aspirate:Scanty, oily fluid
 ‣ Cytological description:Smears show adipocytes with bubbly cytoplasm, foamy macrophages and granular debris. Epithelial cells are absent in the smears. A few chronic inflammatory cells are also present.
 ‣ Reporting category:Benign
 ‣ Diagnosis:Fat necrosis
 ‣ Comments:None


Case summary:

Premenopausal woman presented with painful right breast lump. Diagnosed as oil cyst, BI-RADS 2 on imaging and as fat necrosis on cytology.

Learning points:


  • Oil cyst in the breast is a benign lesion. It is caused by fat necrosis and liquefaction of the necrosed fat. It may occur spontaneously or following breast trauma or surgery. A long-standing oil cyst shows eggshell calcification on mammography, which is a feature that is not seen in simple or complex breast cysts.

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