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

Abstract

Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small‐ and medium‐sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic‐induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin‐induced calciphylaxis. We report a 65‐year‐old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4‐month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10‐2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis‐induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin‐induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow‐up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end‐stage kidney disease.

Nonuremiccalciphylaxis - A Systematic Review

“…As with every systematic review, there is a lack of comprehensive information, potential selection, publishing biases, and a controlled method to reporting in this one. Though NUC has become more widely recognized in recent years, a lack of understanding of the disease, as evidenced by patients' lack of awareness of the disease, may have resulted in under-recognition and, [60][61][62][63][64][65][66][67][68] as a result, confidential reporting of the disease, limiting the representativeness of this systematic review. In addition, we did not disclose attempting to contact the authors of original reports to collect missing data (e.g., time to death, laboratory parameters, histopathologic confirmation, or bone scans), which may lead to some of the stated words being "associated" with the NUC.…”

Early diagnosis strategy of calciphylaxis in dialysis patients

“…Advanced radiological technologies have provided new insights and valuable clues for calciphylaxis diagnosis. In-depth studies of various imaging techniques, such as molybdenum target [ 43 , 44 ], ultrasonography [ 7 , 45 ], and magnetic resonance imaging, are vital for future research. The application of multiple imaging techniques in clinical practice to screen high-risk patients can also provide a basis for determining whether to conduct further invasive pathological examination of skin biopsy.…”

Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies

“…Breast fat necrosis (BFN) is usually considered a benign inflammatory response to breast trauma. AlQattan et al [23] reported the case of a 65-year-old woman with atrial fibrillation who took warfarin. Examination of the histopathology revealed fat necrosis caused by calcification.…”

“…AlQattan et al . [ 23 ] reported the case of a 65-year-old woman with atrial fibrillation who took warfarin. Examination of the histopathology revealed fat necrosis caused by calcification.…”