The significance of spontaneous resolution of breast calcification

Arterial Calcification Disappearance in Breast Imaging: A Key Indicator for Transition to Invasive Ductal Carcinoma

A woman in her 70s, initially suspected of having fibroadenoma due to a well-defined mass in her breast, underwent regular mammography and ultrasound screenings. Over several years, no appreciable alterations in the mass were observed, maintaining the fibroadenoma diagnosis. However, in the fourth year, an ultrasound indicated slight enlargement and peripheral irregularities in the mass, even though the mammography images at that time showed no alterations. Interestingly, mammography images over time showed the gradual disappearance of previously observed arterial calcification around the mass. Pathological examination eventually identified the mass as invasive ductal carcinoma. Although the patient had breast tissue arterial calcification typical of atherosclerosis, none was present around the tumor-associated arteries. This case highlights the importance of monitoring arterial calcification changes in mammography, suggesting that they are crucial indicators in breast cancer diagnosis, beyond observing size and shape alterations.

Disappearing grouped breast calcifications: An ominous sign

Spontaneous disappearing breast calcifications is a rarely-reported phenomenon and the relatively small number of studies that have been done mostly associated the resolution of benign-appearing breast calcifications with benign processes. We present a case of a postmenopausal woman who had spontaneously resolving grouped, coarse heterogenous calcifications in the setting a new soft tissue mass which was pathologically proven to be invasive ductal carcinoma. A handful of studies have shown the resolution of indeterminant calcifications to be associated with malignancy, and interestingly, all of these cases also demonstrated a new parenchymal abnormality which is akin to the present case. Overall, the majority of benign-appearing spontaneous resolving microcalcifications likely are related to benign processes; however, radiologists should be aware of the association of disappearing grouped, indeterminant calcifications with the resulting development of malignancy, especially in the presence of a nearby, newly-forming soft tissue mass.

Spontaneously Disappearing Calcifications in the Breast: A Rare Instance Where a Decrease in Size on Mammogram Is Not Good

Spontaneously resolving breast calcification on mammography is a rare radiologic finding. This phenomenon is defined by a decrease in number and/or prominence of breast calcifications on mammogram when compared to prior imaging. The significance of resolving breast calcifications remains unclear, but they have been reported in cases of malignancy. In current literature, patients whose imaging illustrated a decrease in calcifications usually had other concomitant breast complaints. We are presenting a case of invasive ductal carcinoma, in which the patient was asymptomatic on physical examination. Spontaneously resolving breast calcification and lymphadenopathy were the only abnormal findings on screening mammogram.

Imaging Features of Patients Undergoing Active Surveillance for Ductal Carcinoma in Situ

RATIONALE AND OBJECTIVES

The aim of this study was to describe the imaging appearance of patients undergoing active surveillance for ductal carcinoma in situ (DCIS).

MATERIALS AND METHODS

We retrospectively identified 29 patients undergoing active surveillance for DCIS from 2009 to 2014. Twenty-two patients (group 1) refused surgery or were not surgical candidates. Seven patients (group 2) enrolled in a trial of letrozole and deferred surgical excision for 6-12 months. Pathology and imaging results at the initial biopsy and follow-up were recorded.

RESULTS

In group 1, the median follow-up was 2.7 years (range: 0.6-13.9 years). Fifteen patients (68%) remained stable. Seven patients (32%) underwent additional biopsies with invasive ductal carcinoma diagnosed in two patients after 3.9 and 3.6 years who developed increasing calcifications and new masses. In group 2, one patient (14%) was upstaged to microinvasive ductal carcinoma at surgery. Among the patients in both groups with calcifications (n = 26), there was no progression to invasive disease among those with stable (50%, 13/26) or decreased (19%, 5/26) calcifications.

CONCLUSIONS

Among a DCIS active surveillance cohort, invasive disease progression presented as increasing calcifications and a new mass following more than 3.5 years of stable imaging. In contrast, there was no progression to invasive disease among cases of DCIS with stable or decreasing calcifications. Close imaging is a key follow-up component in active surveillance.

Patient-calibrated agent-based modelling of ductal carcinoma in situ (DCIS): from microscopic measurements to macroscopic predictions of clinical progression

Ductal carcinoma in situ (DCIS)--a significant precursor to invasive breast cancer--is typically diagnosed as microcalcifications in mammograms. However, the effective use of mammograms and other patient data to plan treatment has been restricted by our limited understanding of DCIS growth and calcification. We develop a mechanistic, agent-based cell model and apply it to DCIS. Cell motion is determined by a balance of biomechanical forces. We use potential functions to model interactions with the basement membrane and amongst cells of unequal size and phenotype. Each cell's phenotype is determined by genomic/proteomic- and microenvironment-dependent stochastic processes. Detailed "sub-models" describe cell volume changes during proliferation and necrosis; we are the first to account for cell calcification. We introduce the first patient-specific calibration method to fully constrain the model based upon clinically-accessible histopathology data. After simulating 45 days of solid-type DCIS with comedonecrosis, the model predicts: necrotic cell lysis acts as a biomechanical stress relief and is responsible for the linear DCIS growth observed in mammography; the rate of DCIS advance varies with the duct radius; the tumour grows 7-10mm per year--consistent with mammographic data; and the mammographic and (post-operative) pathologic sizes are linearly correlated--in quantitative agreement with the clinical literature. Patient histopathology matches the predicted DCIS microstructure: an outer proliferative rim surrounds a stratified necrotic core with nuclear debris on its outer edge and calcification in the centre. This work illustrates that computational modelling can provide new insight on the biophysical underpinnings of cancer. It may 1-day be possible to augment a patient's mammography and other imaging with rigorously-calibrated models that help select optimal surgical margins based upon the patient's histopathologic data.

Spontaneous regression of a breast carcinoma: a case report

Spontaneous regression of malignant tumors is a rare event. It is defined as partial or total disappearance of a proven malignant tumor without adequate medical treatment. The causes of this phenomenon are various. Nevertheless, malignant tumors do regress occasionally for no apparent reason, as evidenced by many clinical observations. We report a case of a 68-year-old woman, who was presented with a several-month history of a painless firm lump, initially of 1 cm in diameter and growing to a large solid regular tumor of 2.5 x 2.5 cm in size, in the upper outer quadrant of her right breast. Preoperative histopathological diagnosis revealed ductal invasive carcinoma. Later on, while awaiting surgical treatment, she suffered an arm injury requiring a 1-month delay of surgery. After recovery, on the date of surgery the tumor disappeared, and, in addition, it was not found in tissue specimens obtained from quadrantectomy. After 78 months of follow-up there was no evidence of relapse. In this report, we discuss clinical and histopathological findings, patient management and possible mechanisms of cancer regression.