PMC5568611_01
Photomicrograph from left leg skin punch biopsy showing calcification of dermal arteriole. Diagnostic of cutaneous calciphylaxis when combined with other histologic features and clinical setting (Hematoxylin & Eosin [H&E] stain, original magnification 400x).
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Numerous intravascular thrombi with associated extravasated erythrocytes and areas of ischemic necrosis were noted, and calcifications were confirmed both intrinsic to the walls of small blood vessels and within necrotic connective tissue (Figure 1).
Photograph of the patient's right breast (taken prior to core biopsy) depicting a circumferential area of irregular hyperpigmentation surrounding the nipple-areolar complex with epidermal skin seepage of serous fluid and associated brown-black discoloration and scale crust covering portions of both the nipple and the areola.
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A right breast mass with induration, erythema, mild pain, and a discolored area of skin encompassing the nipple-areola complex was also discovered on physical examination (Figure 2).
Ultrasound of ill-defined breast lesion showing hypoechoic mass with irregular borders. Ultrasound interpreted as BI-RADS 4, suspicious abnormality with differential diagnoses of phlegmon, malignancy, and calciphylaxis. Surgical consultation recommended.
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Color flow and real-time ultrasound examination of the right breast was performed, revealing a 6.8 x 4.8 x 2.1 cm lesion at 10 o'clock posterior depth, 4 cm from the nipple (Figure 3).
Photomicrograph of necrotic tissue in breast core biopsy with ghosted nuclei, extravasated erythrocytes, and a few scattered neutrophils (Hematoxylin and Eosin [H&E] stain, original magnification 200x).
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The remainder of the core biopsy tissue (approximately 90% of the specimen) consisted of expanses of necrosis with no identifiable intrinsic epithelial structures, extravasated erythrocytes, and a few scattered neutrophils (Figure 4).
Photomicrograph of a ghosted terminal ductal lobular unit (TDLU) within breast core biopsy expanse of necrosis (CK7 immunohistochemical study, original magnification 200x).
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A cytokeratin 7 study highlighted a rare ghosted terminal ductal lobular unit (TDLU) within an expanse of necrosis and showed no evidence of sheet-like infiltrating neoplastic cells (Figure 5).
Photomicrograph of ghosted small blood vessel channels with breast core biopsy expanse of necrosis (CD31 immunohistochemical study, original magnification 200x).
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Similarly, a CD31 study highlighted residual ghosted capillary-sized vascular channels (Figure 6).
Axial CT of thorax (study performed for other reasons) demonstrating vascular calcifications intrinsic to the parenchyma of the patient's right breast and additionally supporting the clinical and histologic impressions of calciphylaxis.
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Of note, a thoracic computed tomography study had been recently previously performed (for other reasons), and vascular calcifications were in retrospect noted within the substance of the right breast, additionally supporting the diagnosis of mammary calciphylaxis (Figure 7).