A 67-year-old woman presents with bloody nipple



Doctor's Information

Name :  Maryam
Family :Noori
Affiliation : Teb Azma Imaging Center,Ghom,Iran
Academic Degree: Radiologist
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  ----------------


Case Section

Breast Imaging


Patient's Information

Gender :  Female
Age :  67


Clinical Summary

A 67-year-old woman presents with left bloody nipple discharge.



Imaging Findings

The patient firstly underwent ductography. The abnormal duct easily cannulates but shows wall irregularity, cut off & no normal branching pattern, then note is made of the segmentally distributed granular microcalcifications at UOQ of left breast as a suspicious abnormality which require biopsy for more precise evaluation ( BIRADS IVc). Then the patient referred for ultrasound exam to evaluate about U/S guided biopsy. On U/S exam, a hypoechoic patch is detected which contained some punctate bright echo that represents visualized microcalcifications on mammogram, so U/S guided core biopsy (using 14 gauge automatic needle) was performed.


Differential Diagnosis



Final Diagnosis

Ductal carcinoma insitue (DCIS).


Discussion (Related Text)

The presence of punctate calcifications within solid nodules is a mammographic finding applied to sonography. The presence of calcifications represents a soft sonographic finding more typically associated with DCIS or intraductal components of tumor than with invasive components. Sonography is only 80% as sensitive as mammography for detection of calcifications within malignant nodules. Thus, it generally should be expected that mammography will show all calcifications seen sonographically, but that sonography may fail to show some calcifications that are mammographically visible. However, in occasional cases, sonography may show calcifications that are not prospectively seen on routine mammograms. Such calcifications are usually seen in retrospect on the original films or are demonstrable on spot compression magnification views. The calcifications that occur within malignant tumors are too small to occlude the beam. Thus, malignant calcifications appear sonographically as small, bright echoes that do not cast acoustic shadows. Only if calcifications are the coarse type seen in high-nuclear-grade DCIS, or are so numerous and tightly clustered that they are nearly in direct contact with each other or stacked on one another, do they cause acoustic shadowing. Calcifications can occur in the invasive parts of malignant tumors but more commonly occur within the DCIS components. They are the result of necrosis and occur within the lumen of DCIS-containing ducts. Under ideal circumstances, sonography has the ability to show individual calcium-containing ducts distended with tumor. Thus, calcifications are most often seen within duct extensions, branch patterns , and microlobulations that represent individual tumor-distended ducts. Individual ducts that become distended enough to be visible sonographically are more likely to occur with high-nuclear-grade DCIS components.



Breast ultrasound, Thomas Stovros. Breast Imaging, Daniel B. Kopans et al. Breast Imaging A Correlative Atlas, Beverly Hashimoto & Donald Bauermeister.


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