Calciphylaxis of the Breast: A Case Report and Literature Review

Abstract

Calciphylaxis, or calcific uremic arteriolopathy, is a rare but particularly morbid condition involving systemic medial calcification of arterioles causing ischemia and subsequent tissue necrosis. Although most commonly occurring over the abdomen and proximal extremities, calciphylaxis can present on nearly any skin surface with a tendency toward areas of increased adiposity. We report a case of a 53-year-old female with end-stage renal disease who presented with bilateral palpable breast masses and overlying skin changes. Diagnostic mammography and percutaneous biopsy of the lesion facilitated the diagnosis of calciphylaxis and she was treated with medical therapy, local wound care, and eventual tissue extirpation. Due to the morbidity attributed to calciphylaxis and associated wound complications, surgical extirpation is at times unavoidable. Once malignancy has been excluded, we recommend nonoperative management with prompt referral to Nephrology for medical optimization, reserving surgical debridement for nonhealing wounds and superinfection.

Breast fat necrosis secondary to warfarin‐induced calciphylaxis, a rare mimicker of breast cancer: A case report and a review of literature

“…Also, it has the advantage of illustrating the calciphylaxis as a branching vascular calcifications. On ultrasound, BFN can be seen in different fashions like hyperechogenic areas within the breast or as lesion whether an anechoic cyst with posterior acoustic enhancement, hypoechoic mass with posterior acoustic shadowing, or as an architectural distortion 1,11 …”

“…It is crucial that whenever a lesion is biopsied, care must be taken, as the vascularity would be already compromised by the underlying calciphylaxis. The diagnosis of calciphylaxis is confirmed by histopathology when it demonstrates a (a) mural calcium deposition, (b) thrombi of the calcified vessels, (c) fat necrosis, and (d) inflammatory reaction (lymphocytic, neutrophilic infiltrates, and foamy histiocytes) 11,14 . Although that the hallmark of disease (ie, mural calcification) will appear as a basophilic deposits on the routine hematoxylin and eosin (H&E) stain, Von Kossa stain is one of the tools that can be utilized to demonstrate the calcification whenever needed 11 …”

Bilateral breast calciphylaxis in a patient who survived earlier extensive tissue necrosis 5 years previously: A case report

“…Calcium deposits is a common finding in patients with end-stage renal disease, but the fact that not all of these patients develop calciphylaxis supports a multifactorial cause [ 4 , 13 , 14 ]. Other theorised that calciphylaxis is an active, cell-mediated process including matrix remodelling and deposition [ 8 ]. It is thought to be the end result of a deficiency of several calcification inhibiting proteins, for example matrix Gla protein which is vitamin K dependent.…”

“…Calciphylaxis is a clinical diagnosis although imaging or pathologic examination may be used for confirmation. A handful of cases of breast calciphylaxis were described previously [ [5] , [6] , [7] , [8] ]. However, patients recovering from a first episode of extremity calciphylaxis but developing a second one 5 years later is unique.…”

Calciphylaxis of the Postmenopausal Female Breast: An Uncommonly Encountered Mimic of Carcinoma

“…As a result, diffuse calcification of the media and internal elastic lamina of small- to medium-sized arterioles occurs with intimal proliferation, arterial luminal diminution, and thrombosis causing tissue necrosis. While the classical clinical description of calciphylaxis includes cutaneous areas of erythematous tenderness with violaceous discoloration and hemorrhagic bullae over affected regions (commonly the lower legs), a few reports of calciphylaxis of the breast parenchyma do exist [ 3 – 11 ]. In some instances, calciphylaxis of the breast can lead to subacute or chronic changes of the skin overlying the breast including areas of ulceration, discoloration, and induration that may mimic inflammatory breast carcinoma [ 11 , 12 ].…”