BREAST IMAGING: Calcifications
Case Author: Jiyon Lee, MD, New York University School of Medicine
History
66-year-old woman without symptoms undergoing routine annual surveillance mammography with history of malignant lumpectomy, radiation, and chemotherapy for two sites in the left breast 10 years earlier.
Imaging Findings
Mediolateral oblique (A) and exaggerated craniocaudal (B) mammograms of the left breast show coarse, dense dystrophic calcifications at both lumpectomy sites (indicated by linear scar markers). These calcifications are enlarged compared with findings on previous images. Smaller scattered round calcifications with lucent centers are present.
- Dermal calcifications
- Fat necrosis, dystrophic calcifications
- Recurrent ductal carcinoma in situ
- Secretory calcifications
Diagnosis
Fat necrosis, dystrophic calcifications
Teaching Points
Fat necrosis at a lumpectomy site is initially be seen as a spiculated mass or distortion. After these changes contract or resolve, oil cysts and dystrophic calcifications form in some patients. The rate of recurrence of adequately treated breast cancer is less than 2% over 10 years. The development of indeterminate or suspicious calcifications at a lumpectomy site may warrant biopsy to exclude recurrent cancer. However, calcifications related to early fat necrosis can appear indeterminate or suspicious.
Suggested Readings
Cardenosa G. The altered breast. In: Cardenosa G. Breast imaging. Philadelphia, PA: Lippincott Williams & Wilkins, 2004:313–332
Kopans DB. The altered breast. In: Kopans DB. Breast imaging, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2007:613–638
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