Magnification mammography shows two separate foci of pleomorphic microcalcifications (arrows) in the left breast. There is no associated mass, architectoral distortion or lymphadenopathy.
Facts: Malignant Calcifications on Mammography
- Small -- less than 0.5 mm
- Clustered, segmental
- Character -- fine granular, fine linear, branching (casting) or pleomorphic
Ductal Carcinoma in Situ (DCIS)
- Malignant ductal epithelium without disruption of the underlying basement membrane; normal ductal architecture is preserved.
- Pathological distinguishing feature from lobular CIS is the presence of intercellular cohesion
- Thought to represent early stage of breast cancer
- Several types: comedo, solid, cribiform, clinging (flat-type), mixed
- Grading based on nuclear atypia and necrosis is predictive of prognosis
- Patients are usually asymptomatic
Mammographic Findings
- Cluster(s) of malignant microcalcifications
- If an area of calcifications is larger than 2.5 cm, high likelihood of microinvasion
- If seen with a mass, it could be an intraductal component of an invasive cancer that may require surgical removal and specimen radiography to ensure complete removal
- Mammography should be thoroughly evaluated for multicentric (tumors in different breast quadrants) and multifocal (same quadrant) disease
Our case: Ductal carcinoma in situ, multifocal disease
References:
1. Kopans DB. Breast imaging, 3rd ed, 2007.
2. Conant EF, Brennecke CM. Breast imaging case review series, 2nd ed, 2006.
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