What causes Popcorn appearance in bone, lung, breast, or soft tissues on radiography/CT/mammography?
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Popcorn appearance is caused by coarse, irregular, clustered calcifications or fragmented ossified nodules within a lesion due to chondroid matrix mineralization, dystrophic calcification, or growth-plate/physeal fragmentation; it is classically seen in chondroid bone lesions (enchondroma and chondrosarcoma), pulmonary (chondroid) hamartoma, degenerating fibroadenoma of the breast, calcified uterine leiomyoma, and in children with osteogenesis imperfecta where growth-plate disruption produces metaphyseal/epiphyseal irregular calcified foci.
Why is it called so?
The term “popcorn” describes the macroscopic radiologic pattern of multiple coarse, amorphous, lobulated calcified densities with irregular rings and arcs that cluster and resemble popped kernels of popcorn.
Pathophysiology
Coarse “popcorn” calcifications arise by one of two mechanistic processes: (1) in chondroid tumors and cartilaginous metaplasia, endochondral mineralization of a lobulated cartilaginous matrix produces scattered rings, arcs and nodular calcified foci as cartilage calcifies and fragments; (2) in degenerative or dystrophic settings (degenerating fibroadenoma, leiomyoma, pulmonary hamartoma) fragmented hyaline or fibrous tissue undergoes calcium deposition producing irregular, clustered calcific densities. In osteogenesis imperfecta, abnormal collagen and weakened bone lead to repetitive microtrauma and disordered enchondral ossification with growth-plate fragmentation, producing scalloped, sclerotic-margined calcified nests in the metaphysis that appear as popcorn calcifications.
Alternative names: Popcorn calcification, popcorn calcified appearance
Other associated named signs: Rings and arcs sign (the specific internal calcification pattern often seen within chondroid matrix lesions)
References
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