Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Department of Diagnostic Imaging, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Breast J. 2020 Sep;26(9):1736-1741. doi: 10.1111/tbj.13952. Epub 2020 Jun 21.
Mammary malignancies are radiologically detected by presence of masses, architectural distortions or microcalcifications. Unlike calcium hydroxyapatite, calcium oxalate (CaOx) deposits have been almost exclusively associated with benign mammary processes. The etiology and mechanism of mammary CaOx deposition remains poorly understood, and the original studies elucidating its histopathologic correlation are dated several decades ago. We reviewed radiopathologic findings of breast biopsies and excisions to re-examine the clinicopathologic significance of CaOx deposits and to ascertain potential radiologic characteristics for their identification. Fifty patients from 2004 to 2019 with reported "calcium oxalate" were retrospectively reviewed. CaOx was invariably detected with histopathologic changes of nonproliferative ducts/cysts (90%, 45 of 50), and less commonly, ducts/cysts with usual ductal hyperplasia (10%, 5 of 50). CaOx was missed on one biopsy with a subsequent excision showing apocrine cyst with CaOx. Despite the benign pathological findings, mammographic findings corresponding to CaOx ranged from benign to highly suspicious with 20% categorized as benign (round or punctuate), 22% as intermediate amorphous, 14% as suspicious (coarse/heterogeneous), and 18% as highly suspicious/pleomorphic, respectively. Lobular carcinoma in situ (LCIS) was present in separate fields from CaOx containing benign ducts in two cases which were radiologically characterized as "grouped heterogeneous" and "localized linear." On imaging, more than half of the cases (52.5%) had a corresponding BI-RADS score of 4 and the calcifications were associated with variable distributions and appearances. In conclusion, this is one of the largest studies of CaOx in breast with radiology and pathology correlation. The radiologic appearances of CaOx are nonspecific from benign to highly suspicious. Identification of CaOx on the biopsy is reassuring for a benign diagnosis. Incidental atypical lesions can occur that are often not directly associated with CaOx. CaOx may be overlooked on pathologic evaluation which results in unnecessary surgery. Our findings support close radiologic-pathologic correlation for clinical decision-making pertaining to breast calcifications.
乳腺恶性肿瘤通过存在肿块、结构扭曲或微钙化来放射学检测。与羟磷灰石钙不同，草酸钙（CaOx）沉积几乎仅与良性乳腺过程相关。乳腺 CaOx 沉积的病因和机制仍知之甚少，阐明其组织病理学相关性的原始研究可追溯到几十年前。我们回顾了乳腺活检和切除术的放射病理结果，以重新检查 CaOx 沉积的临床病理意义，并确定其识别的潜在放射学特征。回顾性分析了 2004 年至 2019 年报告的“草酸钙”的 50 名患者。组织病理学改变为非增殖性导管/囊肿（90%，50 例中的 45 例）始终发现 CaOx，不常见的是，导管/囊肿伴有普通导管增生（10%，50 例中的 5 例）。在一次活检中遗漏了 CaOx，随后的切除显示伴有 CaOx 的大汗腺囊肿。尽管存在良性病理发现，但与 CaOx 对应的乳腺 X 线摄影表现从良性到高度可疑不等，20%归类为良性（圆形或点状），22%为中间不定形，14%为可疑（粗糙/不均匀），18%为高度可疑/多形性。2 例病例的良性含 CaOx 导管中存在小叶原位癌（LCIS），分别为放射学特征为“分组性不均匀”和“局限性线性”。在影像学上，超过一半的病例（52.5%）的 BI-RADS 评分对应的为 4，钙化的分布和外观不同。总之，这是最大的与放射学和病理学相关的乳腺 CaOx 研究之一。CaOx 的放射学表现从良性到高度可疑是不特异的。活检中发现 CaOx 可确保良性诊断。偶然会出现非典型病变，这些病变通常与 CaOx 没有直接关系。CaOx 可能在病理评估中被忽视，导致不必要的手术。我们的研究结果支持密切的放射病理相关性，以做出与乳腺钙化相关的临床决策。
