Calcification in breast are areas of calcification of the soft tissues of the breast that have arisen on the background or as a result of other diseases. Clinically, they do not manifest themselves in anything, they are probed in exceptional cases: for large sizes (more than 1 cm) and subcutaneous location. Mammography is used for diagnosis, which is supplemented with a biopsy if necessary. The choice of medical tactics depends on the underlying disease, which caused tissue calcification. Taking into account the revealed pathology, different approaches are used: from dynamic observation to the appointment of hormonal, anti-inflammatory, chemotherapeutic agents, performing operations and radiation.
N64.8 Other specified breast diseases
Usually calcium deposits in one or both mammary glands are detected accidentally during routine mammography. By themselves, they do not threaten the health and life of a woman, but they indicate transferred or existing pathological processes. In 80% of cases calcinates have inflammatory, metabolic, dishormonal or involutive origin, and in 20% they are formed due to the development of malignant neoplasia. With an increase in the quality of medical examinations and the number of mammograms performed, the detection of calcifications in the mammary glands has increased. The relevance of qualitative examination in the detection of calcifications is directly related to the oncological component of the problem.
Calcification in breast tissues occurs with a combination of local morphological changes of an inflammatory, neoplastic or necrotic nature and an increased content of calcium in the body’s liquid media. According to some experts in the field of mammology, calcification of tissues can not only be the result of pathological processes, but also perform a protective function, preventing damage to nearby tissues. The following reasons most often lead to the formation of calcinates:
- Stagnation of milk during lactation. 100 g of female milk contains up to 32 mg of calcium; the pH is from 6.8 to 7.4, and the acidity level normally does not exceed 3-6 ° T. With lactostasis, lactic acid fermentation processes begin, local acidosis occurs, contributing to the loss of calcium salts.
- Diseases of the mammary glands. In patients with mastitis, mastopathy and other breast pathologies, metabolism changes in soft tissues, often an acidic environment is formed that is favorable for the deposition of calcium salts. In addition, with breast cancer, symptomatic hypercalcemia occurs.
- Involution of the mammary glands. In the pathological fibrocystic course of involutive processes, hollow formations with fluid inside appear in the tissues of the mammary glands. In some cases, their walls calcify or an insoluble precipitate falls out of the contents.
- Hypercalcemia. One of the complications of increased calcium content in the blood is deposition in the tissues. Its level increases with certain endocrine and metabolic diseases (hyperparathyroidism, hyperthyroidism, etc.), uncontrolled intake of vitamins A and D, calcium preparations, and a number of malignant tumors.
The mechanism of calcification of tissues is based on the ability of calcium salts to precipitate under conditions of local acidosis. Due to the violation of carbohydrate-lipid metabolism and depletion of buffer systems during the inflammatory process, lactic, pyruvic acid, ketoacids accumulate in the lesion, osmotic pressure increases. As a result, fluid coming from cells and the vascular bed is delayed in the area of inflammation. With an increased concentration of calcium in an inflammatory or necrotic focus with an acidic environment, its salts precipitate in the form of calcinates of different shapes and sizes.
When determining the type of calcification in breast, their number, distribution in tissues, origin, size and shape are taken into account. Most often, calcium deposits are multiple, less often — single. They can form in clusters with a diameter of no more than 1 cm or diffusely disperse in glandular tissue. Depending on the volume of the lesion, calcifications can be segmental, affecting one lobule, and regional, capturing the milky lobe. Sometimes the whole gland is involved in the pathological process. One of the most important classification criteria is localization. There are the following types of calcium formations:
- Ductal. Located in the milky ducts. Most often occur after lactostasis, with duct ectasia and intraductal breast cancer.
- Lobular. They are formed in glandular lobules. They are characteristic of adenosis, fibrocystic variant of mastopathy and calcification of cysts in pathological involution.
- Stromal. They are formed in connective tissue. They are usually isolated and occur with fibroadenomas, cysts, lipomas, atherosclerosis of blood vessels.
The shape and size of calcifications depend on the disease against which they arose, and localization. Thus, ductal calcifications can be worm-like, linear (needle-like) and intermittent (point-like), more characteristic of intra-ductal cancer. Lobular formations resemble in shape a crescent, a bowl or fragments of an eggshell; stromal ones have the appearance of cereals, popcorn, an oval or are shapeless. Microcalcinates are more common in malignant neoplasia, macroformations — in benign processes.
In the presence of calcification in breast, there are no specific symptoms in the vast majority of cases. Mostly calcinates become an accidental find during mammography. Patients usually do not make any complaints or note clinical manifestations characteristic of the underlying disease – pain, discomfort in one or two mammary glands, discharge from the nipples, seals of different sizes and consistency. In the presence of large (more than 1 cm) inclusions located closer to the surface of the skin, they can be felt in the form of dense painless formations. However, such concretions in the mammary glands are extremely rare.
Calcification in breast do not pose any threat to the health and quality of life of a woman. The risk arises only in cases when a patient with calcium deposition in the ducts plans to give birth to a child and breastfeed him. In such situations, the likelihood of lactostasis and postpartum mastitis increases. In women with an anxiety-hypochondriac type of reaction, when calcinates are detected in the breast tissue, carcinophobia may develop. The main danger for patients is associated with the disease that led to the formation of calcium deposits, especially when it comes to malignant neoplasia.
When calcifications are detected in the breast, the diagnostic search is aimed at assessing their size, shape and estimated location, as well as identifying the causes that led to the deposition of calcium salts in the mammary gland. For this purpose, a comprehensive laboratory and instrumental examination is prescribed. The most valuable data for making a correct diagnosis are provided by such methods as:
- Mammography. The main purpose of the study is to obtain preliminary conclusions about the origin of calcinates. On an X-ray image, deposits usually have the same size, structure, clear contours and shape characteristic of lobular and stromal formations. Multiple microcalcinates and formations with vague borders resembling pieces of cotton wool are considered suspicious in terms of the malignant process.
- Cytological examination of the biopsy. It is prescribed if it is suspected that calcification of breast tissue was the result of a malignant process. Tissue fragments obtained by puncture biopsy under X-ray control are sent for histology. If a double fine needle biopsy turned out to be uninformative, a trepanobiopsy is shown, which allows not only to determine the morphological structure, but also, if necessary, to perform an immunohistochemical study.
Ultrasound, MRI, CT, breast scintigraphy, determination of levels of the cancer marker CA 15-3, total and ionized blood calcium, estrogens, FSH, LH can be recommended as additional diagnostic methods. Usually, there are no difficulties with recognizing the detected calcinate, in rare cases, differential diagnosis with fibrocystic mastopathy is carried out. To determine the causes of calcification, an oncologist, an endocrinologist may be involved in the examination.
Therapeutic tactics depend on the causes that provoked the formation of calcifications. In the absence of clinical manifestations, treatment is not prescribed to patients with large stromal formations, and observation by a mammologist is recommended. The combination of calcinates with benign mammary tumors or pathological involution usually requires the use of complex drug therapy. The treatment regimen for such women includes:
- Hormonal drugs. The choice of specific drugs — inhibitors of the secretion of sex hormones, estrogens, progestogens or their combinations — depends on the results of the hormonal background study. When a woman refuses hormone therapy, phytoestrogenic and homeopathic drugs are used.
- Nonsteroidal anti-inflammatory drugs. In most diseases, conditions that contribute to the deposition of calcium salts remain in the tissues of the mammary glands. Therefore, with pain syndrome or other signs of inflammation, hormone therapy is combined with a preventive course of anti-inflammatory treatment.
Effective correction of the diet with the restriction or exclusion of foods containing large amounts of calcium — milk and dairy products, some types of marine fish (for example, sardines), nuts, almonds, sesame, legumes. Calcinates are not surgically removed due to low efficiency, technical complexity and invasiveness of operations. If a malignant neoplasm of the breast has led to the deposition of calcium, an oncologist-mammologist chooses the appropriate method of treatment. At the same time, taking into account the stage of the process and the type of tumor, one of the variants of mastectomy is usually performed, followed by the appointment of hormonal drugs, chemotherapy and radiotherapy.
Prognosis and prevention
The prognosis depends on the underlying pathology in which breast calcifications have arisen, with an asymptomatic course and the absence of a malignant process, it is favorable. For preventive purposes, it is recommended to follow the rules of breastfeeding. When taking medications with calcium and vitamin D, it is important to exclude prolonged exposure to the sun and visiting tanning salons, in the summer, apply formulations with sunscreen filters to the skin. To prevent calcification of breast tissues, timely treatment of gynecological diseases, dishormonal conditions, maintaining a healthy lifestyle with a sufficient level of motor activity, proper rest and nutrition are effective.
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