Image of the Quarter (2015-6)

Unusual luminal crystals in a patient with mammographic calcification

60 year old screener - widespread mammographic calcification - core biopsy.

There was widespread proliferative disease with foci of intermediate grade DCIS associated with phosphate type calcification. In the more benign proliferative areas there were oblong luminal crystals ('Mouse-over') which polarised very weakly.

phosphate calcification and DCIS

These views show a duct on the left partly filled with an atypical columnar cell proliferation and showing luminal phosphate-like cacification. The duct on the right shows less severe changes with a luminal crystalline structure present. The 'Mouse-over' shows weak birefringence with polarised light.

Luminal phosphate calcs (left) and unusual crystal(right)

These views show a cluster of benign glands with large numbers of luminal crystals. The'Mouse-over'shows a closer view of the same.

Luminal crystals and columnar cell lesion

These final views show further detail of these crystals and their appearance under polarised light ('Mouse over').

Unusual luminal crystals associated with columnar cell lesion and view under polarised light

This is an unusual pattern of crystal accumulation within breast ducts. The association with a columnar cell lesion and some luminal secretions focally may give a clue to its histogenesis and chemistry. At the moment I (and colleagues whom I have consulted) would favour an oxalate type crystal but we will have to await further analysis to confirm or deny that assertion.

See also Calcs.

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