Malignant microcalcification (1)

• DCIS - including intracystic papillary carcinoma



• LCIS - usually the pleomorphic variant

See also general practice points, malignant microcalcification (2) and benign microcalcification parts 1 & 2

DCIS

Calcification in DCIS


• May occur with any grade
• Finer calcs associated with low grade DCIS
• Coarse luminal calcs associated with comedo DCIS
• Periductal stromal calcifiaction may be seen alone or as well

Mammogram - cluster of microcalcs (red arrow) typical of high grade comedo DCIS - Courtesy of Jim Walsh & Pat Forrest

Detail of mammogram above - linear calcification in DCIS - Courtesy of Jim Walsh & Pat Forrest

Intermediate grade DCIS and luminal microcalcs:

Intermediate grade DCIS & luminal calcs - specimen X ray showing two guide wires and scattered calcs

Intermediate grade DCIS & luminal calcs

High grade DCIS & calcs

High grade DCIS & luminal calcs

Core biopsy - fragments of intracystic papillary carcinoma (in situ) with luminal calcs

Core biopsy - intracystic papillary carcinoma
- blue circle around shattered calc (left) and uniformly negative CK 5/6 (right)

• This uncommon variant of LCIS is commonly accompanied by comedo necrosis and coarse calcification
• It may easily be mistaken for DCIS for this reason
• The prognosis and management of this lesion if an isolated finding is unclear - see also Florid LCIS

Florid LCIS & luminal calcs

Specimen X ray excision biopsy with localising needle - florid LCIS

Florid LCIS - low power showing expansion of terminal ducts and lobules

Florid LCIS
"A" = terminal duct with Pagetoid subepithelial spread of LCIS cells (arrow)
"B" = area of acinar expansion ++ by LCIS cells

High power view of area of florid LCIS in lobules (left) and uniformly negative E cadherin (right)

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