Home   Chapter Home   Jobs   Conferences   Fellowships   Books

 

 

Advertisement 

 

Breast-nonmalignant

Fibrocystic disease

Microcalcifications of breast

 

Reviewer: Hind Nassar, MD, Johns Hopkins Medical Institute

Revised: 6 October 2012, last major update June 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

=========================================================================

● Deposits of calcium in breast tissue visible on mammographic imaging

 

Terminology

=========================================================================

● Microcalcifications are either calcium phosphate (basophilic, nonbirefringent) or calcium oxalate (seen with polarized microscopy, not H&E, Am J Surg Pathol 1990;14:961, Archives 1989;113:1367, Mod Pathol 1992;5:146)

 

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

 

Xray

=========================================================================

● Suspicious microcalcifications are irregular and fine; non-suspicious 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

 

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)

 

Xray images

=========================================================================

 

  

DCIS

 

Other images: The Radiology Assistant

 

Case reports

=========================================================================

● 61 year old woman with suspicious mammographic calcifications (Case of the Week #25)

● Gold salts within intramammary nodes may simulate microcalcifications (Hum Pathol 1988;19:992)

 

Micro description (Histopathology)

=========================================================================

● 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)

 

Micro images

=========================================================================

 

Calcium oxalate calcifications

                      

With polarized light                                            Without polarized light

 

 

Benign lesions with microcalcifications

               

Fibrocystic disease           Sclerosing adenosis

 

 

                                               

ADH                                        Sclerosing adenosis                                         Mucocele-like lesion

 

 

               

Columnar cell change #1;  #2                          Cystically dilated ducts

 

 

Malignant lesions with microcalcifications

  

Cribriform DCIS      LCIS involving adenosis

 

Virtual Slides

=========================================================================

 

Microglandular adenosis with microcalcifications

 

Positive stains

=========================================================================

● Von Kossa for calcium phosphate

 

Differential Diagnosis

=========================================================================

● FloSeal hemostatic sealant (AJR Am J Roentgenol 2008;191:1371): mimics malignant calcifications

 

Additional references

=========================================================================

eMedicine

 

End of Breast-nonmalignant > Fibrocystic disease > Microcalcifications of breast

 

 

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must also be interpreted in the context of a patient's clinical data using reasonable medical judgment.  This website should not be used as a substitute for the advice of a licensed physician.

 

All information on this website is protected by copyright of PathologyOutlines.com, Inc.  Information from third parties may also be protected by copyright.  Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).