Presentation
Screening mammogram. Unremarkable physical examination: no palpable masses, tenderness, nipple discharge, or nipple inversion.
Patient Data
Bilateral craniocaudal and mediolateral oblique views from a digital screening mammogram demonstrate heterogeneously dense breast tissue with coarse, heterogeneous calcifications in a regional distribution involving the entire upper outer left breast.
Unilateral craniocaudal and mediolateral views from a digital diagnostic mammogram of the left breast demonstrate amorphous calcifications in a segmental distribution spanning 14 cm and involve the entire upper outer left breast.
Digital tomographic mammography-guided stereotactic guided biopsy was performed on the left breast. Biopsy at 200x magnification reveals microcalcifications with the presence of both a comedo architectural type (red arrow) and a cribriform architectural type (yellow arrow). Estrogen (ER) and progesterone (PR) immunohistochemical staining of the specimen shows ER-positive (>95% strong) and PR positive (>5% strong).
Case Discussion
Ductal carcinoma in situ (DCIS) is a classification of neoplastic lesions confined to the breast ducts with no infiltration into the surrounding breast tissue. Most patients with DCIS present asymptomatically, and most cases are found incidentally on screening mammograms. Mammographically, DCIS presents as either linear calcifications or granular calcifications depending on the subtype of DCIS: comedo or non-comedo respectively. On ultrasound, the most common feature is a microlobulated hyperechoic mass with extension into the ducts. DCIS involves 2 or more ducts and/or has a size of more than 2 mm. In this particular case, a biopsy confirmed DCIS.
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