(Radiographics. 1999;19:1401-1403.)
© RSNA, 1999
Residents' Teaching Files 1
Breast Calcifications due to Mönckeberg Medial Calcific Sclerosis
HuiJung Kim, MD ,
Julianne S. Greenberg, MD and
Marcia C. Javitt, MD
1 From the Department of Radiology, The George Washington University Medical Center, 901 23rd St NW, Washington, DC 20037. Received April 16, 1999; revision requested April 29 and received June 2; accepted June 9. Address reprint requests to J.S.G.
Index Terms: Arteries, calcification, 00.817, 949.729 • Arteriosclerosis, 00.817, 949.729 • Breast, calcification, 00.817, 949.729
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Introduction
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Breast arterial calcifications are commonly encountered at mammography. They are usually easily identified as benign findings. The present case illustrates the problem-solving work-up for evaluation of possible arterial calcifications. We present a case of breast arterial calcification that posed a diagnostic dilemma and therefore led to breast biopsy for definitive diagnosis. We describe the typical mammographic and histologic features of vascular calcifications of the breast, as well as the common conditions that coexist with breast arterial calcification.
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CASE PRESENTATION
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A 41-year-old woman presented for baseline screening mammography. She was nulliparous but had no other risk factor for breast cancer. The patient had no history of cardiovascular disease, diabetes, renal disease, or parathyroid problems. She also had no history of breast trauma or surgery.
Screening mammography demonstrated a group of calcifications at the 12-o'clock axis of the right breast. The patient was recalled for additional mammography. Spot magnification views of the right breast revealed a group of amorphous calcifications in a linear arrangement (Fig 1). Their appearance suggested arterial calcification, but this could not be determined with certainty with magnification mammography. In addition, there were no arterial calcifications present elsewhere in either breast.
The options of periodic surveillance versus biopsy were discussed with the patient. She requested excisional biopsy with preoperative needle localization. This decision was made because the patient lacked calcifications elsewhere in the breasts and had no medical history to account for vascular calcification. A radiograph of the specimen revealed a parallel, linear configuration of calcifications, which is typical of vascular calcification (Fig 2). Mönckeberg medial calcific sclerosis was diagnosed.
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DISCUSSION
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Two forms of arterial calcifications are recognized at radiographic and histopathologic analysis: those of the arterial intima (atherosclerosis or nodular arteriosclerosis) and those of the media (Mönckeberg medial calcific sclerosis). Calcifications of the intima appear as relatively large, discontinuous calcific deposits and generally occur in large and medium-sized arteries. Calcifications of the media are more fine grained and diffuse and tend to involve the entire circumference of peripheral arterioles (1). It is the latter form (Mönckeberg medial calcific sclerosis) that occurs in the breast and that is identified at mammography as vascular calcification. Intimal, atherosclerotic calcifications have not been observed in breast tissue submitted for histopathologic evaluation and are not known to occur in the breast (Schwartz A, oral communication, 1999).
Arterial calcifications of the breast are benign findings. They are identified on screening mammograms in 9.1% of women (2). At mammography, medial arterial calcifications typically appear as linear, parallel calcifications in a "railroad track" configuration. In the vast majority of cases, vascular calcifications of the breast are readily identified as such and pose no significant diagnostic dilemma. In the early stages of formation, medial arterial calcifications in the breast may not appear typically benign at mammography, occasionally having a linear or ductal appearance (3). In the case presented herein, the classic parallel configuration of calcification was not apparent until a radiograph of the specimen was obtained (Fig 2).
At histopathologic analysis, Mönckeberg medial calcific sclerosis appears as ringlike calcification within the media of small to medium-sized vessels (4) (Fig 3). There is no associated thickening of the intima (1). The exact pathogenesis of Mönckeberg medial calcific sclerosis is unknown, and there is no known inciting injury of the media. This entity is reported to be rare in patients less than 50 years old (4).
At mammography, visible arterial calcifications of the breast are positively correlated with increased age and are seen more frequently in postmenopausal women (5). Breast arterial calcification was reported by Baum et al (6) as a sign of coexisting diabetes. Sickles and Galvin (7) refuted the association between arterial calcifications on mammograms and diabetes as too weak to be clinically useful. These authors emphasized the expected strong association between breast arterial calcification and increasing age. Schmitt et al (8) found no significant difference in the mammographic prevalence of vascular calcifications between age-matched diabetic patients and control patients. Conversely, Moshyedi et al (9) reported that nearly all of the women in their study group younger than 59 years with breast arterial calcifications also had coronary artery disease and diabetes mellitus. Patients with a history of chronic renal failure have been reported to have a higher prevalence of breast arterial calcifications (45%) than patients with normal renal function (8%) (10).
The clinical significance of breast arterial calcification in relation to other conditions associated with atherosclerosis is unknown. However, this is an interesting question in view of the fact that vascular calcifications of the breast are apparently not due to atheromatous, intimal disease. Presently, it can only be concluded that breast arterial calcification can be a coexistent finding in patients with conditions that predispose to atherosclerosis, such as diabetes or coronary artery disease. However, the patient in our case had no history of any factor predisposing to or coexisting with peripheral arterial calcification in the breast or elsewhere.
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References
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Lindbom A. Arteriosclerosis and arterial thrombosis in the lower limb: a roentgenological study. Acta Radiol 1950; 80(suppl):1-80.
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VanNoord PA, Beijerinck D, Kemmerenen JM, Graaf Y. Mammograms may convey more than breast cancer risk: breast arterial calcification and arterio-sclerotic related diseases in women of the DOM cohort. Eur J Cancer Prev 1996; 5:483-487.[Medline]
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Bassett LW. Mammographic analysis of calcifications. Radiol Clin North Am 1992; 30:93-105.[Medline]
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Cotran RS, Kumar V, Collins T. Robbins pathologic basis of disease 6th ed. Philadelphia, Pa: Saunders, 1999.
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Leinster SJ, Whitehouse GH. Factors which influence the occurrence of vascular calcification in the breast. Br J Radiol 1987; 60:457-458.[Abstract/Free Full Text]
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Baum JK, Comstock CH, Joseph L. Intramammary arterial calcifications associated with diabetes. Radiology 1980; 136:61-62.[Abstract/Free Full Text]
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Sickles EA, Galvin HB. Breast arterial calcification in association with diabetes mellitus: too weak a correlation to have clinical utility. Radiology 1985; 155:577-579.[Abstract/Free Full Text]
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Schmitt EL, Norbeck JM, Threatt B. Incidence of mammary intra-arterial calcification: an age-matched control study. South Med J 1985; 78:1440-1442.[Medline]
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Moshyedi AC, Puthawala AH, Kurland RJ, O'Leary DH. Breast arterial calcification: association with coronary artery disease. Radiology 1995; 194:181-183.[Abstract/Free Full Text]
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Sommer G, Kopssa H, Zazgornil J, Salomonowitz E. Breast calcification in renal hyperparathyroidism. AJR 1987; 148:855-857.[Abstract/Free Full Text]
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Introduction
CASE PRESENTATION
