Primary Breast Amyloidosis Presenting as Microcalcifications Only
A 72-year-old woman was referred to our hospital for further evaluations of calcifications detected on a screening mammography taken at another hospital. The patient had a 5-year history of diabetes mellitus. No other abnormality was evident from basic laboratory examinations. No breast symptoms were evident such as pains, palpable masses, or nipple discharges. Mammography demonstrated multiple, irregular calcifications in the subareolar area of the left breast; they were regionally distributed, generally smooth-branched, linear, and rod-like, and varied in sizes and shapes (). These calcifications were classified as category "4A": low suspicious findings at final assessment according to the Breast Imaging Reporting and Data System (). Thus, a biopsy was recommended and the patient underwent surgical excisional biopsy with mammoguided needle localization. Specimen mammography revealed several irregular-shaped calcifications (). There were no discrete mass evidences on the gross pathology. Histopathology examination revealed dystrophic calcifications in ectatic mammary ducts, amorphous eosinophilic material deposition; the infiltration of periductal lymphocytes and multinucleated giant cells were revealed upon hematoxylin-eosin staining (). The calcifications were stained with Congo-red and exhibited apple-green birefringence under polarizing microscopy () which were consistent with amyloidosis. No malignancies were pathologically identified. Immunohistochemistry confirmed the AL type amyloidosis. Our patient refused further investigations, and there was no clinical evidence suggesting generalized amyloidosis in her physical or laboratory results. There was no interval change in calcifications of the left breast on follow-up mammography for five years. During the follow-up period of five years, no clinical or laboratory evidence of systemic amyloidosis has been demonstrated.