January 18, 2010

Ductal Carcinoma in Situ

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

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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