Korean J Radiol.  2017 Apr;18(2):323-335. 10.3348/kjr.2017.18.2.323.

Imaging Patterns of Intratumoral Calcification in the Abdominopelvic Cavity

• Yu MH
• Kim YJ
• Park HS
• Jung SI
• Jeon HJ

• KMID: 2427944
• DOI: http://doi.org/10.3348/kjr.2017.18.2.323

Abstract

Intratumoral calcification is one of the most noticeable of radiologic findings. It facilitates detection and provides information important for correctly diagnosing tumors. In the abdominopelvic cavity, a wide variety of tumors have calcifications with various imaging features, though the majority of such calcifications are dystrophic in nature. In this article, we classify the imaging patterns of intratumoral calcification according to number, location, and morphology. Then, we describe commonly-encountered abdominopelvic tumors containing typical calcification patterns, focusing on their differentiable characteristics using the imaging patterns of intratumoral calcification.

Keyword

Abdominopelvic neoplasm; Calcification

MeSH Terms

Abdominal Neoplasms/complications/*diagnosis/diagnostic imaging
Adenocarcinoma, Mucinous/diagnosis/diagnostic imaging/pathology
Adult
Aged
Calcinosis/complications/*diagnosis/diagnostic imaging
Female
Humans
Image Interpretation, Computer-Assisted
Liver Neoplasms/diagnosis/diagnostic imaging/pathology
Male
Middle Aged
Neoplasm Metastasis
Pancreatic Neoplasms/diagnosis/diagnostic imaging/pathology

Figure

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  Fig. 1 Imaging patterns of intratumoral calcification according to number, location, and morphology. Calcification is seen–in tumors–in single or multiple form, and can be located in center or peripheral portion of tumor, or at internal septa (septal). Punctate (round), amorphous (irregularly shaped), curvilinear (curved line), or rim (eggshell, cyst-wall like appearance) calcification is in evidence.

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  Fig. 2 Mucinous adenocarcinoma of stomach in 60-year-old female. Axial contrast-enhanced CT image shows diffuse, low-attenuated wall thickening containing multiple punctate calcifications (arrowheads) involving high-to-low body of stomach. These CT findings are characteristic imaging features of gastric mucinous adenocarcinoma.

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  Fig. 3 Mucinous adenocarcinoma of colon in 22-year-old female. Coronal contrast-enhanced CT image reveals segmental, low-attenuated wall thickening (arrow) at descending colon, causing upstream colonic obstruction (asterisk). Several punctate calcifications (arrowheads) are seen in low-attenuated, thickened colon wall. Patient underwent left hemicolectomy and was diagnosed with mucinous adenocarcinoma.

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  Fig. 4 Mucinous cystic neoplasm of pancreas in 31-year-old female. Axial contrast-enhanced CT image demonstrates large, well-defined, low-attenuated cystic mass with multiple internal septa in pancreatic tail (not shown). Typical septal calcifications (arrowheads) are noted within lesion. Distal pancreatectomy was performed, and mucinous cystic neoplasm was diagnosed.

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  Fig. 5 Mucinous cystic neoplasm of pancreas in 51-year-old female. A. Bulging, contoured, low-attenuated cystic mass in pancreatic tail is seen on axial contrast-enhanced CT image. There are multifocal enhancing solid components (asterisks) in mass, and peripheral curvilinear calcification (arrowhead) is also in evidence. B. This coronal T2-weighted MR image demonstrates presence of cystic mass with internal solid portion (asterisk). Peripheral curvilinear calcification (arrowhead) of lesion is seen as region of hyposignal intensity. After distal pancreatectomy, mucinous cystic neoplasm with associated invasive carcinoma was diagnosed.

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  Fig. 6 Mucinous cystic neoplasm of liver in 56-year-old female. Large, well-defined, unilocular cystic mass (asterisk) is located in left lateral section of liver as shown on axial contrast-enhanced CT image. Peripheral curvilinear calcification (arrowhead) is noted, and there is no enhancing solid component. Hepatic segmentectomy was performed, and lesion was confirmed as being mucinous cystic neoplasm (biliary cystadenoma) with dystrophic calcification and containing internal hemorrhage.

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  Fig. 7 Mucinous cystic neoplasm of liver, in 75-year-old female. A. On axial pre-contrast CT image, lobulating, contoured cystic mass is located in segment 7 of liver. Fine septal calcifications (arrowheads) are seen. B. On ultrasound scan, fine septal calcifications (arrowheads), within cystic mass, are seen as echogenic lesions with posterior acoustic shadowing. After hepatic tumorectomy, mucinous cystic neoplasm (biliary cystadenoma) was diagnosed.

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  Fig. 8 Mucinous neoplasm of appendix in 61-year-old male. Coronal contrast-enhanced CT image demonstrates cystic dilatation of appendix (asterisk) without evidence of acute inflammation. Curvilinear calcification (arrowhead) is seen at proximal appendiceal wall. Appendectomy was performed, and low-grade appendiceal mucinous neoplasm was diagnosed.

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  Fig. 9 Mucinous adenocarcinoma of appendix in 72-year-old male. Axial contrast-enhanced CT image reveals cystic dilatation of appendix (asterisk) with peripheral, curvilinear calcifications (arrowheads). Internal, mild enhancing solid portions and perilesional fatty infiltrations are demonstrated. After appendectomy, mucinous adenocarcinoma was diagnosed.

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  Fig. 10 Hepatic metastasis from breast cancer in 60-year-old female. A, B. Small low-attenuated lesion with tiny calcification (arrowheads) is noted in left lateral section of liver. Metastatic tumor from breast cancer was confirmed via percutaneous biopsy.

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  Fig. 11 Hepatic metastases from colon cancer in 60-year-old female. A. Multiple low-attenuated metastases (arrows) are located in both liver lobes on axial contrast-enhanced CT image. B. On follow-up CT image taken after patient underwent chemotherapy, multiple previous metastases are decreased in size, and amorphous intratumoral calcification (arrowhead) is newly developed.

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  Fig. 12 Hepatic hemangiomas in 67-year-old female. A, B. There are two small hemangiomas (arrows) in left lobe of liver. On axial pre-contrast CT scan (A), small punctate calcification (arrowhead), known as phlebolith, is seen at small hemangioma (arrows) in left lateral section. Although dynamic contrast-enhanced CT that showed typical progressive centripetal enhancement is not seen, hemangiomas (arrows) show peripheral nodular enhancement and punctate calcification on axial portal venous phase image (B).

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  Fig. 13 Mesenteric hemangioma in 47-year-old male. On coronal, maximum-intensity projection CT image, small, round, soft tissue lesion is found in left-sided small bowel mesentery (arrow). Two small punctate calcifications (arrowheads) are seen within lesion. After mass excision, this lesion was confirmed as being mesenteric hemangioma.

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  Fig. 14 Sigmoid colon hemangioma in 22-year-old male. Axial contrast-enhanced CT image demonstrates segmental concentric bowel wall thickening (arrows) with multiple punctate calcifications (arrowheads, phleboliths) involving sigmoid colon. This multiple punctate calcification pattern is characteristic imaging feature of gastrointestinal hemangioma.

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  Fig. 15 Mature cystic teratomas in 40-year-old female. On coronal contrast-enhanced CT image, bilateral ovarian fatty masses containing punctate calcification (arrowheads) are visible. These are pathognomonic radiologic findings of mature cystic teratoma.

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  Fig. 16 Mature cystic teratomas in 55-year-old female. Bilateral mature cystic teratomas are found on axial pre-contrast CT image. In left mature cystic teratoma, presence of peripheral, thick, rim calcification (arrow) and central punctate calcification (arrowhead) are simultaneously noted. Right mature cystic teratoma contains single punctate calcification (arrowhead).

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  Fig. 17 Gastrointestinal stromal tumor in 61-year-old male. A. Exophytic lobulating contoured enhancing mass is seen in stomach high-body greater curvature on coronal contrast-enhanced CT image. Mass contains small, dense punctate calcification (arrowhead) and internal, low-density necrotic portion (asterisk). B. On coronal T2-weighted MR image, small dense punctate calcification (arrowhead) is seen as region of hyposignal intensity. Internal necrotic portion (asterisk) within mass appears as region of high signal intensity. Gastrointestinal stromal tumor was confirmed.

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  Fig. 18 Solid pseudopapillary neoplasm of pancreas in 28 year-old female. A. On axial contrast-enhanced CT image, low density mass (asterisk) with thick peripheral, rim calcification (arrowhead) is located in pancreatic tail. Main pancreatic duct is not dilated. B. On ultrasound scan, bulging contoured mass (asterisk) is suspected in pancreatic tail. Peripheral, rim calcification (arrowheads) of mass appears as hyperechogenicity with posterior acoustic presentation. Solid pseudopapillary neoplasm was diagnosed after distal pancreatectomy.

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  Fig. 19 Pancreatic neuroendocrine tumor in 54-year-old female. A. On axial contrast-enhanced CT image, large lobulating contoured hypervascular mass (asterisk) is located in pancreatic tail. Lesion contains multiple amorphous calcifications (arrows and arrowheads) at central and peripheral portions of mass. B. On contrast-enhanced T1-weighted image, dense calcifications (arrowheads) appear as dark signal intensity at center of mass (asterisk). However, other peripheral amorphous calcifications (arrows on A) are not clearly visualized. This mass was confirmed as neuroendocrine tumor (grade 2) after distal pancreatectomy.

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  Fig. 20 Multiple schwannomas in 39-year-old female. Coronal contrast-enhanced CT image demonstrates multiple round masses (asterisks) in retroperitoneum, which are confirmed as schwannomas. Punctate and curvilinear calcifications (arrowheads) are seen in some tumors.

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  Fig. 21 Castleman disease in 30-year-old male. A. On coronal contrast-enhanced CT image, well-defined hypervascular retroperitoneal mass (asterisk) is found. Multiple amorphous calcifications (arrowheads) are noted within mass. B. On ultrasound scan, well-defined hypoechoic mass (asterisk) is revealed. Multiple intratumoral calcifications (arrowheads) are seen as echogenic portions with or without posterior acoustic shadowing. After mass excision, lesion was confirmed as Castleman disease.

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