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BIRADS IV lesion

Case contributed by Dr Nikola Todorovic


The patient has never had breast imaging. Her menarche was at the age of 13, and she still has regular periods. Also, she had no deliveries. Her sister died of breast cancer and her mother of colon cancer. Asymptomatic.

Patient Data

Age: 50 years
Gender: Female

On 12 o' clock in the right breast, there is a hypoechoic solid lesion, where I was not able to certainly distinct is there one bilobated or two adjacent lesions. Maximal diameter of the lesion is around 25 mm. The lesion is lobulated and not completely parallel to the skin, has no increased vascularity and distinct posterior phenomenon.

There is the hyperechoic rim, but it is somehow interrupted with lobulations.

There were no pathologic axillary lymph nodes.

Case Discussion

A lesion like this can be characterized as a fibroadenoma, but it has some unusual characteristics (micro lobulation, non-parallel orientation). 

Taking into consideration family and personal history, lesion's characteristics and the fact that the patient had her first imaging breast examination at the age of 50, I decided to grade this as a BIRADS IV lesion.

I suggested her to perform a mammography immediately, but she refused.

My final report was BIRADS IV for the right breast, and also a strong advice for a mammography as soon as possible because of the further lesion evaluation.


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Case information

rID: 52907
Published: 25th Apr 2017
Last edited: 14th Aug 2019
System: Breast
Inclusion in quiz mode: Excluded

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