[A woman with a painful swelling in the breast]. / Een vrouw met een pijnlijke zwelling in de borst.

BACKGROUND: A hibernoma is a rare benign lipomatous tumour, consisting of brown and white fat cells. In general, a hibernoma is an asymptomatic swelling that increases slowly in size, but it can sometimes cause pain. CASE DESPRIPTION: A 62-year-old woman presented at the breast clinic with a painful swelling in the right breast that was increasing in size. Radiological examination initially suggested a hamartoma. However, on the basis of histological examination of a biopsy, the diagnosis of hibernoma was made. The hibernoma was removed surgically. CONCLUSION: A hibernoma of the breast can grow to such a size that pain can arise due to compression of the mammary parenchyma. Surgical resection is only indicated if the hibernoma causes symptoms or for cosmetic reasons.

Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ - The LORD study.

BACKGROUND: The current debate on overdiagnosis and overtreatment of screen-detected ductal carcinoma in situ (DCIS) urges the need for prospective studies to address this issue. A substantial number of DCIS lesions will never form a health hazard, particularly if it concerns non- to slow-growing low-grade DCIS. The LORD study aims to evaluate the safety of active surveillance in women with low-risk DCIS. DESIGN: This is a randomised, international multicentre, open-label, phase III non-inferiority trial, led by the Dutch Breast Cancer Research Group (BOOG 2014-04) and the European Organization for Research and Treatment of Cancer (EORTC-BCG 1401). Standard treatment will be compared to active surveillance in 1240 women aged ⩾ 45 years with asymptomatic, screen-detected, pure low-grade DCIS based on vacuum-assisted biopsies of microcalcifications only. Both study arms will be monitored with annual digital mammography for a period of 10 years. The primary end-point is 10-year ipsilateral invasive breast cancer free percentage. Secondary end-points include patient reported outcomes, diagnostic biopsy rate during follow-up, ipsilateral mastectomy rate and translational research. FEASIBILITY: To explore interest in and feasibility of the LORD study we conducted a survey among EORTC and BOOG centres. A vast majority of EORTC and BOOG responding centres expressed interest in participation in the LORD study. The proposed study design is endorsed by nearly all centres.