17 - Calcifications in the major ducts - 3/3

This lecture is the continuation of Part II, structured by Teaching points, which are supported by challenging and educational cases, using the multimodality approach. This disease may extend far beyond the mammographically detectable microcalcifications, so that MRI is necessary to delineate the true extent of the disease for appropriate treatment planning. Surgical removal restricted only to the tissue with calcifications will leave the most actively growing part of the malignancy behind in the breast. Patients with casting type calcifications on the mammogram are poor candidates for breast conserving or skin sparing surgery, because the malignant process is contiguous within the duct system, often extending from the nipple to the skin and chest wall, making their local control difficult. Thorough correlation of multimodal imaging with large format thin and thick section (3D) histopathology reveals an unnaturally large number of tightly packed, contorted ducts and duct-like structures with periductal desmoplastic reaction, lymphocytic infiltration and a lack of associated TDLUs.

Postoperative radiotherapy and chemotherapy are poorly effective against this subtype of breast cancer, as documented by a high fatality rate which has not diminished during the past 40 years.