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Case 3

Case History

A 69-year-old woman with a right breast lump.

Physical Examination

• right breast: a 3 cm flat, mobile mass extends from the 1:00 to the 4:00 positions

• left breast: normal exam

Mammogram

Mass (Fig. 3–1)

• margin: circumscribed

• shape: oval

• density: fat-containing

Figure 3–1. In the right inner inferior breast there is a circumscribed mass containing fat (arrows). The mass is partially obscured by the surrounding breast parenchymal density. (A). Right MLO mammogram. (B). Right CC mammogram.

Ultrasound

Frequency

• 13 MHz

Mass

• margin: well defined

• echogenicity: heterogeneous

• retrotumoral acoustic appearance: no shadowing

• shape: ellipsoid (Fig. 3–2)

Figure 3–2. Right radial breast sonogram: The palpable lump corresponds to a well-defined mass of heterogeneous echogenicity. The appearance of this mass is confusing because within the mass are multiple focal fatty areas (isoechoic with fat), which are mistaken as individual masses and are measured separately. (Electronic caliper markers measure one fatty area.) The actual mass is a combination of the fatty masses and the more hyperechoic fibroglandular tissues (arrows).

Pathology

• hamartoma

Management

• BI-RADS Assessment Category 2, benign finding

Pearls and Pitfalls

In the literature, hamartomas have also been designated as fibroadenolipomas and adenolipomas. Hamartomas have been reported in patients with a mean age in the late 30s to early 40s. Clinically, the hamartoma may present as a palpable mass, an incidental finding on mammography, or sometimes as tenderness. Rarely a patient presents with nipple inversion or discharge. If the mammogram is performed first, the lesion can be confidently identified if it contains fat. Generally, this mass is not removed. However, in a series in which the tumor was removed, it has been reported to recur in up to 8% of patients.