Types of Calcifications 1

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Ductal calcifications:
    • Have a wide variety of presentations depending upon the underlying process that created them
  • When coarse rod-like ductal calcifications are diffuse, bilateral, and not confined to a single lobe:
    • They can be confidently assumed to result from plasma cell mastitis, and do not require further evaluation or biopsy (Image)
  • The process is called secretory disease:
    • Because there is a stagnant, viscous fluid that eventually petrifies and results in the smooth contoured calcifications
    • Some of them are branching and look like malignant casting type calcifications:
      • But the key distinguishing feature is the diffuse, multilobe, bilateral nature of the process:
        • Calcifications become much more worrisome when they are confined to a single lobe
  • The most frequent malignant, ductal “casting type” calcifications are:
    • Fragmented, linear, and branching, and they are the most reliable mammographic sign of malignancy (Image)
Casting type calcification.
  • The presence of fragmented and / or dotted casting type calcifications on the mammogram restricted to one lobe:
    • Is a pathognomonic sign of a diffuse, grade 3 breast cancer subtype that originates in the major ducts and usually has a solid or micropapillary pattern:
      • Traditionally, this subtype has been called “comedo carcinoma”
    • The cancer cells either produce a viscous, proteinaceous fluid, which gradually concentrates and eventually calcifies, or they undergo necrosis (apoptosis) followed by calcification:
      • In both instances, the intraluminal pressure increases, distending the ducts considerably
  • Dotted casting type calcifications:
    • Have been referred to as “snakeskin-like calcifications” and they accumulate in the fluid produced by either micropapillary or solid cancer cell growth patterns (Image)
    • The tips of the micropapillary growths may become detached and eventually calcify, contributing to the intraluminal calcifications (Image)
Snakeskin type calcifications.
The micropapillary growths break off and calcify in the lumen, resulting in the individual dots of calcification (the dark, almost black stained structures).
  • Occasionally, malignant ductal calcifications present in a manner that can be easily mistaken for a benign process:
    • It occurs when fluid production, rather than necrosis, dominates the picture
    • The intraductal carcinoma can be grades 1, 2, or 3 and a micropapillary and/or cribriform architecture is present
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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