A 52-year-old woman with no history of breast disease presented for routine screening mammography... more A 52-year-old woman with no history of breast disease presented for routine screening mammography. Breast tomosynthesis (3-D mammography) revealed a 0.3-cm nodule with associated pleomorphic calcifications within the outer central right breast (Fig. 1a). A sonographic correlate was not appreciated for the nodule and stereotactic core biopsy was performed. The specimen radiograph showed punctate microcalcifications within a well-circumscribed radiodense nodule (Fig. 1b). Microscopic examination showed a benign lymph node containing brown-black refractile pigment (Fig. 2), which was initially thought to represent tattoo pigment, mainly confined to histiocytes. Calcifications were not appreciated in adjacent benign breast tissue in multiple H&E levels examined. X-ray of the paraffin block containing the lymph node revealed punctate calcifications in a similar distribution as intranodal pigment seen in the histologic section. Additional clinical information was obtained. The patient did not have any tattoos. Her history was significant for rheumatoid arthritis, for which she received multiple intramuscular gold injections over a 20-year period. With this history and the histologic features in the biopsy, gold was determined to be the source of intranodal pigment which mimicked calcification on mammography. Mammography is the standard procedure for early detection of breast carcinoma which frequently manifests with characteristic patterns of microcalcifications. Intramuscular gold therapy, or chrysotherapy, has been used to treat rheumatoid arthritis for more than 75 years. Up to 50% of gold injected remains in the body and persists in tissues many years after cessation of parenteral chrysotherapy. Gold mimicking calcifications in axillary lymph nodes and intramammary lymph nodes has been previously documented. Other benign sources or mimics of calcification in lymph nodes include tattoo pigment, fat necrosis, and calcification associated with granulomatous diseases and post-Bacille Calmette-Guerin vaccination. It is important to recognize that foreign material in lymph nodes can manifest as mammographic calcifications, and when necessary, pathologists should request further clinical information from radiologists regarding the presence of tattoos or history of chrysotherapy in order to Address correspondence and reprint requests to: Paula S. Ginter, MD, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, Starr 1036, New York, NY 10065, USA, or e-mail: psg9003@nyp.org
A 52-year-old woman with no history of breast disease presented for routine screening mammography... more A 52-year-old woman with no history of breast disease presented for routine screening mammography. Breast tomosynthesis (3-D mammography) revealed a 0.3-cm nodule with associated pleomorphic calcifications within the outer central right breast (Fig. 1a). A sonographic correlate was not appreciated for the nodule and stereotactic core biopsy was performed. The specimen radiograph showed punctate microcalcifications within a well-circumscribed radiodense nodule (Fig. 1b). Microscopic examination showed a benign lymph node containing brown-black refractile pigment (Fig. 2), which was initially thought to represent tattoo pigment, mainly confined to histiocytes. Calcifications were not appreciated in adjacent benign breast tissue in multiple H&E levels examined. X-ray of the paraffin block containing the lymph node revealed punctate calcifications in a similar distribution as intranodal pigment seen in the histologic section. Additional clinical information was obtained. The patient did not have any tattoos. Her history was significant for rheumatoid arthritis, for which she received multiple intramuscular gold injections over a 20-year period. With this history and the histologic features in the biopsy, gold was determined to be the source of intranodal pigment which mimicked calcification on mammography. Mammography is the standard procedure for early detection of breast carcinoma which frequently manifests with characteristic patterns of microcalcifications. Intramuscular gold therapy, or chrysotherapy, has been used to treat rheumatoid arthritis for more than 75 years. Up to 50% of gold injected remains in the body and persists in tissues many years after cessation of parenteral chrysotherapy. Gold mimicking calcifications in axillary lymph nodes and intramammary lymph nodes has been previously documented. Other benign sources or mimics of calcification in lymph nodes include tattoo pigment, fat necrosis, and calcification associated with granulomatous diseases and post-Bacille Calmette-Guerin vaccination. It is important to recognize that foreign material in lymph nodes can manifest as mammographic calcifications, and when necessary, pathologists should request further clinical information from radiologists regarding the presence of tattoos or history of chrysotherapy in order to Address correspondence and reprint requests to: Paula S. Ginter, MD, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, 525 East 68th Street, Starr 1036, New York, NY 10065, USA, or e-mail: psg9003@nyp.org
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