Punctate intranodal gold deposits simulating microcalcifications on mammograms

Area of Science:

• Radiology
• Rheumatology
• Oncology

Background:

• Axillary lymph nodes are commonly visualized on mammograms.
• Opacities resembling punctate calcific deposits within these nodes are rare.
• Existing literature offers limited guidance on the interpretation of these findings.

Purpose of the Study:

• To investigate the nature of punctate calcific deposits observed in axillary lymph nodes on mammograms.
• To differentiate between malignant and benign causes of these calcifications.
• To explore the association with chrysotherapy in rheumatoid arthritis patients.

Main Methods:

• Retrospective review of mammograms showing axillary lymph node calcifications.
• Correlation with patient clinical histories, particularly rheumatoid arthritis and chrysotherapy.
• Histopathological confirmation where available.

Main Results:

• Extensive punctate calcifications in axillary lymph nodes are rarely indicative of breast cancer metastases.
• These calcifications are frequently associated with intranodal gold deposits.
• The findings were confirmed in one patient and suspected in three others with a history of rheumatoid arthritis and prolonged chrysotherapy.

Conclusions:

• Punctate calcific densities in axillary lymph nodes on mammograms are more commonly associated with gold deposits from chrysotherapy in rheumatoid arthritis patients.
• This appearance is a rare manifestation of metastatic breast cancer.
• Radiologists should consider chrysotherapy history when encountering such mammographic findings.