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CALCIFICATIONS in Carcinoma of the breast

Malignant calcifications can be detected mammographically in approximately 50% of cases. About 20% of breast carcinomas present only with calcification. Granular calcifications appear as tiny dotlike or somewhat elongated densities that are irregularly grouped close together in a cluster and resemble a stone crushed by a sledgehammer. Casting calcification refers to that formed in segments of irregular ductal lumen containing necrosis and debris from increased cellular activity.

Imaging Findings:
Calcification is extremely variable in distribution, size, form, density, and number. Malignant calcifications tend to form in clusters and are generally smaller, less dense, and more irregular than typical benign calcifications. In a single cluster, calcifications often vary in size, shape, and density.

Carcinoma of the breast. (A) Numerous tiny calcific particles with linear (arrows), curvilinear (solid arrowhead), and branching (open arrowhead) forms characteristic of malignancy. Note the benign calcification in the wall of an artery, which is easily recognized by its large size and tubular distribution (curved arrow).

(B) Magnification view in another patient shows a retroareolar tumor containing coarse calcifications. One centimeter medial to the tumor is a small cluster of calcifications (arrows) without a tumor shadow.