J Korean Soc Radiol.  2019 May;80(3):591-597. 10.3348/jksr.2019.80.3.591.

Invasive Breast Cancer Presenting as a Mass Replaced by Calcification on Mammography: A Report of Two Cases

• Jeun JH
• Lee JH
• Cho E
• Kim SJ
• Park EH
• Byun KD

• KMID: 2454041
• DOI: http://doi.org/10.3348/jksr.2019.80.3.591

Abstract

A distinct calcification pattern is one of the criteria for determining the malignancy of breast cancer according to the Breast Imaging Reporting and Data System. A mass almost entirely replaced by calcification, however, is difficult to categorize and likely to be misdiagnosed. We present the report of two patients with invasive carcinoma of the breast that presented as a mass replaced by calcification on mammography. In the first case, the mass was confirmed as a mixed carcinoma comprising mucinous and micropapillary carcinoma, and in the second case, the mass was a mucinous carcinoma. Diagnosis of cancer in the latter case was missed as the mass had been assessed as a category 2 typically benign calcification at the first screening mammography 2 years ago. This report merits publication because it shows that a mass replaced by calcification on mammography can be misdiagnosed as a benign finding.

MeSH Terms

Adenocarcinoma, Mucinous
Breast Neoplasms*
Breast*
Calcinosis
Diagnosis
Humans
Information Systems
Mammography*
Mass Screening
Mucins
Publications
Mucins

Figure

• 

  Fig. 1 A 50-year-old woman with a mixed-type mucinous carcinoma. A. Right mediolateral oblique mammogram shows a calcified mass, measuring 24 mm, with an oval shape and circumscribed margins in the clinically palpable upper inner area (arrow). B. Breast ultrasound image shows an irregular, indistinctly marginated, markedly hypoechoic mass with posterior shadowing. C. Subtraction image of dynamic contrast-enhanced breast MRI shows a heterogeneously enhancing mass (arrow) and a satellite enhancing nodule (open arrow). The kinetic curve shows initial fast and delayed plateau enhancement pattern (inset). D, E. In the surgical specimen, the mass shows collisional features with two histologically different types of carcinoma. The area on the right comprises a mucinous carcinoma with an abundant extracellular mucin pool, floating tumor cells, and multifocal microcalcifications (D, hematoxylin & eosin stain, × 10, arrow: microcalcification). The area on the left comprises a micropapillary carcinoma with central dense calcification and diffuse microcalcifications within micropapillary tumor cells (E, hematoxylin & eosin stain, × 200, arrows: microcalcification).

• 

  Fig. 2 A 46-year-old woman with a pure-type mucinous carcinoma. A. Left craniocaudal screening mammogram obtained at another hospital shows a calcified mass, measuring 13 mm, with circumscribed margins in the left central area. The mass had been assessed as a category 2 typically benign finding. B. Follow-up left magnification mammogram obtained after 2 years for a palpable lump in the left breast shows a mass with an increased size and a new group of calcifications in the left subareolar area (arrow). C. Breast US image obtained at another hospital shows an oval-shaped, circumscribed, and hyperechoic mass (open arrows) with suspected echogenic calcifications (arrow). D. In the excised specimen, a well-defined mass consisting of an abundant extracellular mucin pool with some floating carcinoma cells is observed. Diffuse microcalcification is noted within the mucin pool and tumor cells [hematoxylin & eosin stain, × 10 (inset: × 200); arrows: microcalcification; asterisk: mucin pool]

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