Pleomorphic calcifications (crushed stone appearance) and some type of casting associated with ductal carcinoma in situ

Case contributed by Dr Valerio Giacalone

Presentation

Patient undergoing mammography prevention screening.

Patient Data

Age: 45 years
Gender: Female

The group of non-specific calcifications remained unchanged. After six months, however, a new group of pleomorphic calcifications (flattened stone morphology) and some casting-type calcifications appeared in a median position, malignant characteristics.

A grouping of irregular, amorphous and non-specific calcifications can be seen in the mid-external quadrant of the right breast.

Case Discussion

This case illustrates the evolution at six months of a group of non-specific calcifications in the absence of suspicious opacities. The group of non-specific calcifications remained unchanged. After six months, however, a new group of pleomorphic calcifications (crushed stone morphology) and some casting type calcifications appeared in a median position. On stereotactic biopsy, the result was ductal carcinoma. Magnetic resonance imaging (not shown) was performed and found a higher proportion of pathological tissue than mammographic examination.

Often suspicious mammographic features are only the "tip of the iceberg" and underestimate the true extent of the tumor; MRI can help us detect the true extent of the disease, as in this patient's case.

Today, compared to the past, it is preferable to biopsy a group of amorphous calcifications immediately, without waiting for the evolution in the following six months.

 

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