Casting-Type Calcifications

Introduction Chapter 1: Description of calcifications localized within the ducts Anatomic background Secretory disease-type, plasma-cell-mastitis type calcifications Casting-type calcifications Fragmented and dotted casting type calcifications Fragmented casting type calcifications on the mammogram Dotted casting type calcifications on the mammogram Fragmentted casting-type calcifications Mammographic display of widespread fragmented casting type calcifications in five separate cases Macroscopic and subgross histologic correlation when fragmented casting type calcifications fill an entire lobe Characteristic mammographic and histologic presentation of fragmented casting type calcifications on the mammogram Example 1.1 Mammographic-histologic correlation when both fragmented and dotted casting type and dotted casting type calcifications are present Example 1.2 Fragmented casting-type calcifications, differential diagnostic problems Fragmented casting-type calcifications which bear a resemblance to benign secretory disease type calcifications Example 1.3 Fragmented casting-type calcifications may be deceptive, particularly when presenting as a small cluster Examples 1.4, 1.5 Dotted casting-type calcifications Mammographic display of widespread dotted casting type calcifications in five separate cases Mammographic-histologic correlation of dotted casting type calcifications on the mammogram Examples 1.6-1.9 Mammographic-histologic correlation of dotted casting type calcifications caused by Grade 1 DCIS, a rare event Examples 1.10, 1.11 Chapter 2: The evolution of casting-type calcifications Introduction No apparent abnormality on the previous mammogram Example 2.1 Cluster of calcifications as the earliest sign Examples 2.2-2.9 Subtle casting type calcifications as the earliest sign Examples 2.10, 2.11 Chapter 3: The theory of neoductgenesis Introduction Comparison of benign and malignant intraductal calcifications Proposal of the theory of neoductgenesis Morphologic demonstration of neoductgenesis A) Unnaturally high concentration of duct-like structures B) Desmoplastic reaction and extensive lymphocytic infiltration C) Disorganized architecture D) Pathologic ducts, contorted and crowded closely together Histologic demonstration of multiple newly formed ducts Examples 3.1-3.3 E) Tenascin overexpression Examples 3.4, 3.5 Neoductgenesis with asymmetric density and very subtle, associated calcifications Example 3.6 Neoductgenesis without associated calcifications Examples 3.7, 3.8 Chapter 4: The deviant nature of the breast cancer subtype with castings Introduction The use of mammographic tumor features to study breast cancer Relative frequency of breast cancer occurrence by mammographic tumor features Long-term outcome by mammographic tumor features Proportion of breast cancer death by mammographic tumor features Demonstration of fatal cases with casting type calcifications Examples 4.1-4.3 Poor correlation of outcome with mode of therapy Demonstration of local recurrence following radiotherapy Examples 4.4, 4.5 Axillary node status and mammographic tumor features Histologic malignancy grade and mammographic tumor features Outcome of 1-14 mm casting cases compared with advanced cancers Chapter 5: Recognition of the unpredictable, often fatal nature of the breast cancer subtype presenting with casting type calcifications on the mammogram Examples with fatal outcome Examples 5.1-3 Frequent recurrence with casting type calcifications Examples 5.4-5.7 Distant metastases with casting type calcifications Example 5.8 Suggestion for use of the mammographic prognostic features in clinical practice