Name : Mojgan
Affiliation : Radiology Department,Mahdieh Hospital ,SBMU
Academic Degree: Assistant Professoe of Radiology
Resident : Hussein Soleimantabar
Gender : Female
Age : 53
53-year-old female with screening mammogram
A segmental distribution of granular-type calcifications of varying size, shape and density is evident in LIQ of left breast, which is highly indicative of malignancy.
High grade DCIS (comedo type)
Discussion (Related Text)
Malignant calcifications vary in shape and size. The margins of the calcifications are jagged and irregular. Malignant calcifications are often branching. Ductal carcinoma in situ (DCIS), or noninvasive breast cancer, is most often detected mammographically as a result of such calcifications. Groups of pleomorphic calcifications that are more linear or dot-dash in appearance are more commonly associated with high-nuclear-grade intraductal carcinomas that have luminal necrosis (comedocarcinomas). The lower-grade (cribriform and micropapillary) types are often manifest by more punctate or granular appearing calcifications. The morphology of the calcification cannot, however, be used to predict the subtype of DCIS because there is considerable overlap in the forms of the calcification associated with each subtype; frequently, multiple DCIS subtypes exist together in the same lesion. In the high-grade (comedo) subtype, the calcifications can be an approximate indication of the size of the tumor, although the extent of disease is often greater than mammographically predicted. In the lower-grade varieties, correlation is even poorer. The biologic behavior of these subtypes also differs; high-grade types are the most likely to recur. Pleomorphic microcalcifications in association with a malignant soft tissue mass can also indicate areas of extensive intraductal component within or adjacent to the invasive tumor. It is especially important to recognize malignant calcifications that occur in tissues surrounding invasive cancers so they can be excised with the invasive tumor. Such extensive intraductal component positive cancers also have a greater tendency to recur.
Brant, William E.; Helms, Clyde A. Fundamentals of Diagnostic Radiology, 3rd Edition