A 57-year-old asymptomatic woman, screening examination. Called back to the assessment center for further examination of the small cluster of calcifications in her left breast detected at screening.
Ex. 2.1 -1 & 2 Mediolateral oblique (MLO) projection and detail of the MLO view of the left breast A small cluster of calcifications is seen without an associated tumor mass.Ex. 2.1-3 Craniocaudal (CC) projection of the left breast. The small cluster of calcifications is located in the retroglandular clear space.Ex. 2.1-4 Microfocus magnification in the CC projection. The individual calcifications are closely spaced and vary in size and density, and their shape resembles crushed stones. These are of the mammographically malignant type.Ex. 2.1-5 & 6 Stereoscopic image pair of a 1 mm-thick slice of the TDLU containing the crushed stone-like calcifications seen on the specimen radiograph. It is apparent from these images that the in situ carcinoma is confined to the acini of the distended TDLU and is not within ducts. Although such cancers are still termed “ductal” carcinoma in situ, 3D histological images show that this is not the case. There were no other malignant foci in the specimen, but several types of hyperplastic changes were found adjacent to the malignant focus (see Figs. 2.1-12 to 17).Ex. 2.1-7 Specimen radiograph showing the malignant type calcifications removed with a good margin (15 mm at histological examination).Ex. 2.1-8 & 9 Stereoscopic images of the TDLUs containing the in situ carcinoma. The individual acini are markedly distended by the combination of malignant cellular growth, central necrosis, and intraluminal amorphous calcification. The TDLUs measure 6 and 3 mm in diameter, with each individual acinus being larger than a normal-sized TDLU.Ex. 2.1-10 & 11 Medium- and high-power magnification histological images, with a-smooth-muscle actin immunostaining demonstrating a preserved myoepithelial cell layerthat outlines a single acinus distended by many layers of Grade 2 in situ carcinoma, central necrosis, and amorphous calcification.Ex. 2.1-12 & 13 Comparison of two adjacent TDLUs. The one on the left is altered by in situ carcinoma and the one on the right is deformed by sclerosing adenosis.Ex. 2.1-14 & 15 Stereoscopic images of TDLUs distended by fluid. The underlying hyperplastic breast change is apocrine metaplasia (seen as micropapillary growths within the cystically dilated acini).Ex. 2.1-16 & 17 The fluid produced by the apocrine metaplasia has distended several ducts and their branches. Normal TDLUs surround the dilated ducts.
Treatment and follow-up: Wide surgical excision with no adjuvant therapy. The patient was free of disease at the most recent follow-up 13 years following surgery.
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Group 1A: Example 2.2
Classification of Crushed Stone-like Calcifications Produced by Malignant Processes
Overview of the Diagnostic and Management Problems Encountered When Malignant Type Calcifications Are Detected on the Mammogram
14 Urothelial Cancer and Transitional Cell Cancer
7 Colorectal Hepatic Metastatic Disease: Ablation
13 Emerging Technologies in Interventional Oncology
