What is Your Diagnosis

Vascular calcifications: Vascular calcifications are naturally frequent in older patients but they may also be found in younger women suffering from diabetes or renal insufficiency (Fig. 12.12). The calcifications homogeneously line the vascular walls with an appearance of two fine parallel lines. Their differentiation from calcium within the glandular ducts is unproblematic in most cases.

I Plasma Cell Mastitis

Pictures Calcification Lines Mammogram

Fig. 12.14 Plasma cell mastitis is characterized by stiletto-like, smoothly marginated and dense calcifications located within the glandular ducts and pointed toward the mamilla. So this is a pretty safe diagnosis. But beware: Patients with plasma cell mastitis, as all other women, can also develop a breast carcinoma. Remember the "satisfaction of search" effect and always carefully scrutinize the entire mammogram even if you find an obvious diagnosis!

Fig. 12.12 This vessel (arrows) displays fine, regular calcifications along its wall. This appearance is characteristic and can hardly be confused with more ominous intraductal calcifications.

Fig. 12.14 Plasma cell mastitis is characterized by stiletto-like, smoothly marginated and dense calcifications located within the glandular ducts and pointed toward the mamilla. So this is a pretty safe diagnosis. But beware: Patients with plasma cell mastitis, as all other women, can also develop a breast carcinoma. Remember the "satisfaction of search" effect and always carefully scrutinize the entire mammogram even if you find an obvious diagnosis!

I Ductal Carcinoma In Situ

Sclerosing Adenosis

Ductal Carcinoma Situ Calcification

Fig. 12.15 Here they are—the little dog's paw-like calcifications of the sclerosing adenosis. They must be analyzed with extreme care and frequently one will resort to a core needle biopsy: Malignant calcifications are not that different in appearance and may be present on a radiograph that also shows extensive sclerosing adenosis, distracting the radiologist. The comparison with previous films is therefore especially crucial.

Fig. 12.15 Here they are—the little dog's paw-like calcifications of the sclerosing adenosis. They must be analyzed with extreme care and frequently one will resort to a core needle biopsy: Malignant calcifications are not that different in appearance and may be present on a radiograph that also shows extensive sclerosing adenosis, distracting the radiologist. The comparison with previous films is therefore especially crucial.

Plasma cell mastitis: In plasma cell mastitis, solid, rod-shaped calcifications are formed within the glandular ducts of the breast (Fig. 12.14). These calcifications are much more regular and denser than malignant calcifications.

Fig. 12.17 a This dedicated stereotactic table is used to perform core biopsies with a vacuum needle. In this technique a hollow needle is advanced into the immediate vicinity of the calcifications with high precision. Tissue is then sucked into a lateral opening of the needle, excised with a circular cutting knife, and removed from the inner core of the needle while the outer wall of the needle remains in place. These steps are

I Ductal Carcinoma In Situ

Malignant Breast Calcification Images
Fig. 12.16 These irregular calcifications follow the course of the glandular ducts and therefore appear branching. This is a ductal carcinoma in situ.

Sclerosing adenosis: Sclerosing adenosis of the breast goes along with scattered microcalcifications, almost always bilateral, that are round, grouped, and rather regular (Fig. 12.15). The Dutch love to call them "hondepotjes" (little dog's paws).

Ductal carcinoma in situ (DCIS): The DCIS consists of a cellular heap that replicates and spreads within the glandular ducts. It is characterized by fine and branching calcifications (Fig. 12.16). The neighborhood is rarely infiltrated. The DCIS can encompass a large part of the ductal system and may also occur in different divisions of the gland. The repeated, rotating the needle in a clockwise fashion until the entire tissue surrounding the needle has been sampled. b The magnified specimen radiograph of the harvested cores confirms that the microcalcifications are included in the tissue sample. It is only then that you can be certain to have targeted and removed tissue from the correct region in the breast.

Sclerosing Adenosis

I Stereotactic Biopsy

I Stereotactic Biopsy

Right Breast Stereotactic Core Biopsy

Fig. 12.17 a This dedicated stereotactic table is used to perform core biopsies with a vacuum needle. In this technique a hollow needle is advanced into the immediate vicinity of the calcifications with high precision. Tissue is then sucked into a lateral opening of the needle, excised with a circular cutting knife, and removed from the inner core of the needle while the outer wall of the needle remains in place. These steps are determination of invasiveness cannot be made on a mammogram.

• Diagnosis: The calcifications in Mrs. Lamour's breast are irregularly configured and arranged in a triangular formation oriented toward the nipple, much like a "flock of wild geese" as some call it. Hannah has another, closer look together with Dr. Skywang. Unfortunately, there is little doubt that these are malignant calcifications. Ultrasound of the area is unremarkable: the calcifications are too small to detect and no discrete soft tissue mass is discernible. Mrs. Lamour takes the bad news calmly but she wants something to be done quickly. An appointment for a stereotactic needle biopsy is made for the next day (Fig. 12.17a). After the procedure, the harvested tissue cores are radiographed once again to verify that they do indeed contain the suspicious microcalcifications (Fig. 12.17b). The histological examination finds a DCIS with smaller invasive components.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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Responses

  • Henriikka
    Do branching calcficaitions mirror the ducts?
    5 years ago

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