Findings: In the superolateral aspect of the right breast, there is a 3 x 3 cm area of extensive branching pleomorphic calcifications. Additional benign dystrophic and vascular calcifications are also present.

Diagnosis: Ductal carcinoma in situ (DCIS), comedo subtype.

Discussion: Ductal carcinoma DCIS is a malignant intraductal epithelial proliferation, which confined by the basement membrane. It manifests with a variety of histologic patterns and can be broadly divided into comedo and noncomedo subtypes.

Comedo refers to the plug-like appearance of necrotic material that fills the affected ducts. This necrotic debris results in the typical fine, linear branching pattern of calcifications seen on mammography.

Comedo DCIS is considered the more aggressive subtype with more malignant cytologic features and behavior. It has, therefore, a higher probability of microinvasion. It is interesting to note that in this particular case that despite the extensive amount of DCIS no invasion was seen on pathology.

References:
Rebner M, Raju J. Noninvasive Breast Cancer. Radiology. 1994;190:623-631.

Basset LW, et al. Diagnosis of Diseases of the Breast, Philadelphia,
W. B. Saunders Co., 1997.

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