Popcorn-like Calcification in the Breast: More Than Meets the Eye?
N Abdullah, R Sridharan, A Saeid, IM Rose, ZM Annuar
Hong Kong J Radiol 2015;18:152-5
DOI: 10.12809/hkjr1514274
We present a case of a 56-year-old woman who had mammographic findings of coarse popcorn-like calcification in the right breast. In year 2000, the patient had benign lumps in both breasts, which were excised. Subsequent ultrasound examination revealed a 0.7 cm x 0.4 cm hypoechoic nodule. The lesion displayed irregular superficial margin and thus was assigned Breast Imaging Reporting and Data System category 4 with a decision to proceed with a biopsy. Core needle biopsy and histopathology showed involuting fibroadenoma without evidence of malignancy. In view of the discordant results, subsequent excision was performed which confirmed osseous metaplasia. This case report aimed to describe a relatively rare occurrence of mammary osseous metaplasia arising from an involuting fibroadenoma. Coarse popcorn-like calcifications on mammogram are commonly thought to be invariably benign and are therefore not subjected to further imaging or follow-up. What is not commonly known, however, is the fact that these calcifications can progress to osseous metaplasia as demonstrated in this patient. Literature reviews have shown a few cases of mammary osseous metaplasia that transformed into osteosarcoma. Therefore, this case deserves to be highlighted to radiologists and surgeons alike that mammographically detected coarse popcorn-like calcification in the breast could in fact represent osseous metaplasia. Henceforth, such cases warrant a more thorough evaluation, and possibly excision with histopathological evaluation to exclude sarcomatous transformation.
中文摘要
爆米花狀（粗大鈣化）的乳房鈣化：並非如眼所見？
N Abdullah, R Sridharan, A Saeid, IM Rose, ZM Annuar
本文報告一名56歲女性，乳房鉬靶檢查/X線檢查顯示其右側乳房有粗大的爆米花狀鈣化影。2000年時，病人兩側乳房曾發現有良性腫塊，已手術切除。隨後的超聲檢查發現0.7厘米 × 0.4厘米的低迴聲結節。病灶邊緣形態不規則，被認定為BI–RADS Ⅳ級，並決定進行活檢明確。穿刺活檢和組織病理學顯示為複雜性纖維腺瘤，無支持惡性腫瘤的依據。由於不同檢查結果不完全一致，決定為病人進行切除，後被確診該病灶為骨化生。這個病例意在報道由複雜性纖維腺瘤引起的乳腺骨化生，這是相對少見的病例。乳房鉬靶檢查/X線檢查中見到粗大的爆米花狀鈣化一般被視為良性，且不會安排進一步的影像學檢查及隨訪。然而，從這個病例所見，與常規不同，這些鈣化可能會演變成骨化生。文獻亦有記載少數病例是從乳腺骨化生轉化為骨肉瘤。放射科和外科醫生應加倍留意，如果乳房鉬靶檢查/X線檢查顯示有粗大的爆米花狀鈣化，可能代表有骨化生。如有類似情況便須為病人作全面評估，可以的話應作切除及組織病理學評估以排除肉瘤病變的可能性。