Breast - nonmalignant
Fibrocystic disease
Microcalcifications of breast

Author: Hind Nassar, M.D. (see Authors page)

Revised: 1 August 2017, last major update June 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Microcalcifications in breast [title]

Cite this page: Microcalcifications. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastcalcification.html. Accessed October 20th, 2017.
Definition / general
  • Deposits of calcium in breast tissue visible on mammographic imaging
Terminology
Epidemiology
  • Can occur at any age but more common after menopause
Etiology
  • Can be associated with both benign and malignant lesions
Clinical features
  • Presence of microcalcifications on mammography has led to detection of breast tumors as small as 1 - 2 mm
  • Microcalcifications are present in 50% of carcinomas versus 20% of benign breast disease but only 20% of "suspicious" microcalcifications are actually part of a malignant process
Radiology description
  • Suspicious microcalcifications are irregular and fine; nonsuspicious are coarse and chunky
  • Pathologists must detect microcalcifications in glass slides that correspond to those in radiographs - if not present, submit additional tissue, obtain additional levels or use polarized microscopy to look for calcium oxalate (Pathologica 2007;99:5)
  • Exhaustive searching for microcalcifications yields a small increase in specific diagnostic information but with a high technical cost (Mod Pathol 2001;14:350)
  • Note: microcalcifications may be missing from biopsy due to retrieval failure (Radiology 2006;239:61)
  • Note: recommended to examine all vacuum assisted breast biopsy specimens histologically, even those without microcalcifications (Eur Radiol 2008;18:925)
  • Detection of calcium phosphate microcalcifications is reduced with glyoxal fixative (Hum Pathol 2004;35:1058)

Radiologic BI-RADS (Breast Imaging Reporting and Data System of American College of Radiology) classification:
  • Category 0 - need additional imaging evaluation
  • Category 1 - negative
  • Category 2 - benign finding
  • Category 3 - probably benign finding - short term interval follow up suggested
  • Category 4 - suspicious abnormality - biopsy should be considered
  • Category 5 - highly suggestive of malignancy - appropriate action should be taken
  • References: American College of Radiology: ACR BI-RADS® Atlas, Fifth Edition, 2013

  • Suggested that radiologists subcategorize BI-RADS 4 as 4A (low suspicion for malignancy), 4B (intermediate suspicion of malignancy) and 4C (moderate concern but not classic for malignancy, Breast J 2010;16:28)

LeGal classification of microcalcifications
  • Type 1 - annular
  • Type 2 - regularly punctiform
  • Type 3 - too fine for precizing the shape
  • Type 4 - irregularly punctiform
  • Type 5 - vermicular (Bull Cancer 1984;71:57)
Radiology images

Images hosted on other servers:

DCIS

Various images

Case reports
Microscopic (histologic) description
  • Calcium phosphate microcalcifications are associated with benign and malignant disease; are blue / purple psammoma like chunks
  • Calcium oxalate crystals are typically within benign cysts or terminal ductules that are histologically apocrine or GCDFP-15 positive; are associated with LCIS but only rarely with invasive carcinoma (Am J Surg Pathol 1991;15:586)
  • Calcium oxalate crystals may be present in centrifuged fixative (Am J Surg Pathol 1997;21:255)
Microscopic (histologic) images

Images hosted on PathOut server:

Calcium oxalate calcifications:

With polarized light

Without polarized light



Benign lesions with microcalcifications:

ADH

Sclerosing adenosis



Images hosted on other servers:

Benign lesions with microcalcifications:

Fibrocystic disease

Mucocele-like lesion

Columnar cell change

Cystically dilated ducts



Malignant lesions with microcalcifications:

Cribriform DCIS

LCIS involving adenosis

Virtual slides

Images hosted on other servers:

Microglandular adenosis with microcalcifications

Positive stains
Differential diagnosis