DCIS left breast

Case contributed by Dr Garth Kruger

Presentation

Routine screening mammogram left breast. No previous for comparison.

Patient Data

Age: 55
Gender: Female
Modality: Mammography

Micocalcifications of DCIS.

This case shows all the hallmarks you would want to see in DCIS. This is the Mappa Mundi of DCIS. The calcifications are "wild and crazy", there are X's, Y's and Z's visible haphazardly distributed on a segment of the breast. Look carefully at the distribution; you can see the calcifications in a ductal distribution as the DCIS grows out of blood supply and calcifies in response.

Case Discussion

In general, the wilder and crazier the microcalfications, the higher the grade of DCIS.

Note superiorly how far the calcifications extend to the top of the image with "normal" breast in between.. Mammography underestimates the extent of the disease; the degree and distribution of the calcifications is less than the disease extends into the breast. Just surgically removing the calcifications does not guarantee the disease has been completely removed. Hence the roll of radiation in the therapy of DCIS.

In practice, ultrasound is useful. You can actually see these calcifications on ultrasound and biopsy them under ultrasound guidance. 

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Case Information

rID: 21706
Case created: 13th Feb 2013
Last edited: 7th Feb 2016
System: Breast
Inclusion in quiz mode: Included

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