Misleading Presentation of Multilesional Benign Pathologies in the Breast: A Diagnostic Challenge

A 41-year-old female presented to our service, referred by the oncology department for evaluation of multiple nodules in the right breast. Upon questioning, the patient reported that she had sought consultation for multiple dermal lesions present for approximately 20 years in the right areolar region. However, upon examination, the physician noted palpable breast nodules and requested imaging studies for better characterization. An excisional biopsy of one of the breast nodules was subsequently performed for histopathological analysis. Because the patient's primary concern was the longstanding dermal lesions, one of these was also excised and submitted for histopathological evaluation. The breast nodule was diagnosed as fibrocystic mastopathy, while the dermal lesion was identified as a keloid scar. Comprehensive multimodality breast imaging, including mammography, ultrasound, and contrast-enhanced MRI, is essential for accurate characterization of palpable nodules, particularly when clinical findings and patient-reported symptoms are discordant. Radiologic-pathologic correlation is especially critical in the presence of multiple lesions of differing tissue origins to ensure accurate diagnosis and appropriate management of both dermal and breast parenchymal conditions.