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Case 14

Case History

A 48-year-old woman presents with a new palpable right lump.

Physical Examination

• right breast: palpable lump at the 10:00 position

• left breast: normal exam

Mammogram

Mass (Fig. 14–1)

• margin: obscured

• shape: oval

• density: equal density

Figure 14–1. In the right upper outer quadrant, there is an oval mass (arrow) with obscured margins, which corresponds to the palpable lump demarcated with a metallic marker. (A). Right MLO mammogram. (B). Right CC mammogram.

Ultrasound

Frequency

• 13 MHz

Mass

• margin: well defined

• echogenicity: hypoechoic

• retrotumoral acoustic appearance: single edge shadowing

• shape: lobulated (Fig. 14–2)

Figure 14–2. Right antiradial breast sonogram: At the 10:00 position, there is a hypoechoic, lobulated mass that corresponds to the mass identified in Figure 14–1.

Pathology

• fibrocystic changes

• stromal hyalization, microscopic cysts, and apocrine metaplasia

Management

• BI-RADS Assessment Category 4, suspicious; biopsy should be considered

Pearls and Pitfalls

1. In retrospect, the sonographic appearance of the mass correlates well with the histology as small cysts are evident within the lesion.

2. Fibrocystic changes generally cause symptoms in premenopausal women. About 75% of affected women are in the fourth or fifth decade. Three clinical stages have been described. Initially, women note premenstrual breast swelling or pain. Later, they develop breast lumps. Finally, the period of breast tenderness becomes continuous throughout the menstrual cycle. After menopause, the symptoms wane. Although at autopsy 25% of women have fibrocystic changes, only 10% of women older than 60 years have symptoms.