ARRS Case of the Week

BREAST IMAGING: Calcifications

Case Author: Tanya W. Moseley, MD, The University of Texas M. D. Anderson Cancer Center

History

70-year-old woman who underwent right segmentectomy for ductal carcinoma in situ and invasive ductal carcinoma 4 years ago.

Women's Imaging Virtual Symposium

Imaging Findings

Right craniocaudal (A) and lateromedial (B) mammograms show a surgical scar (circle) in the 10-o’clock position of the upper outer quadrant. Craniocaudal (C) and lateromedial (D) magnification images confirm the presence of the calcifications (arrow) adjacent to the postsurgical bed. Compared with findings on previous mammograms (not shown), these calcifications are new.

What is the correct diagnosis?

  1. Dystrophic calcifications (fat necrosis)
  2. Coarse popcornlike calcifications (fibroadenoma)
  3. Amorphous calcifications (sclerosing adenosis)
  4. Large rodlike calcifications (plasma cell mastitis)

Correct Answer

Dystrophic calcifications (fat necrosis)

Teaching Points

Fat necrosis of the breast is a benign nonsuppurative inflammatory process that results from an insult to adipocytes (fat cells). The development of fat necrosis may cause diagnostic dilemmas because both the clinical and the imaging presentations of fat necrosis can mimic those of malignancy.

The imaging appearance of fat necrosis is variable, ranging from benign to suspicious for malignancy. Mammographically, fat necrosis may appear as eggshell or rim calcifications, coarse calcifications, dystrophic calcifications, focal asymmetries, architectural distortions, and spiculate masses.

Developing calcifications in or near the postsurgical site that cannot be confidently diagnosed as fat necrosis (dystrophic) calcifications are worrisome for cancer recurrence and should be biopsied.

Suggested Readings

Krishnamurthy R, Whitman GJ, Stelling CB, et al. Mammographic findings after breast conservation therapy. RadioGraphics 1999; 19:S53–S62

Taboada JL, Stephens TW, Krishnamurthy S, et al. The many faces of fat necrosis in the breast. AJR 2009; 192:815–825

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