Imaging Sciences Interesting Cases
Case 79
Christopher Mosley, MD
Clinical Presentation: A 79-year-old female presented for routine screening mammography.
Imaging Findings: The breast tissue is composed of scattered fibroglandular elements. There are multiple rod- and cigar-shaped calcific densities consistent with secretory calcifications in bilateral breasts. Vascular calcifications are also noted. There is no evidence of suspicious microcalcifications, emerging masses, architectural distortion or other signs of malignancy. BI-RADS Category 2.
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| Figure 1A-D. Multiple rod- and cigar-shaped calcifications are seen within the bilateral breast consistent with secretory breast calcifications. | |
Diagnosis: Secretory Breast Calcifications
Discussion: Secretory breast calcifications are benign calcifications within either the lumen or wall of dilated, debris-filled ducts. These calcifications appear in a ductal, branching pattern, radiating away from the nipple and are usually bilateral. Secretory calcifications are typically dense and thick, measuring approximately 1.0 mm or less in diameter and between 3-10 mm in length. Secretory calcifications may have a rod- or cigar-shape with tapered ends. Rarely, they may display lucent centers. Secretory type calcifications have a very typical appearance on mammography. Breast ultrasound may demonstrate dilated retroareolar ducts which are hypoechoic or anechoic. MRI may demonstrate ductal ectasia with a bright branching pattern on pre-contrast T1WI if protinaceous fluid is present.
Clinically, nearly all cases of secretory breast calcifications are asymptomatic. In cases where symptoms do develop, palpable breast thickening may occur. Rarely, nipple retraction may result. Secretory calcifications usually do not occur before 60 years of age.
Main differential diagnosis is ductal carcinoma in situ (DCIS).References:
- THE ACR Breast Imaging Reporting and Data System (BI-RADS®) - Mammography, 4th ed. Reston, VA:American College of Radiology, 2003.
- Olson SL, Fam BW, Winter PF, et al. Breast calcifications: analysis of imaging properties. Radiology. 1988 Nov;169(2):329-32. [PubMed]
- Sickles EA. Breast calcifications: mammographic evaluation. Radiology. 1986 Aug;160(2):289-93. [PubMed]