What causes popcorn calcification in chondroid bone lesions on plain radiographs?
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On plain radiographs, popcorn calcification is caused by the progressive calcification of the hyaline cartilage matrix within benign cartilaginous tumors, most notably enchondromas, but also in other chondroid lesions such as chondrosarcoma or osteochondroma. It is also observed in some fibrotic lesions (e.g., pulmonary hamartoma, degenerating fibroadenoma of the breast, calcified uterine fibroid) and, in the setting of osteogenesis imperfecta, represents abnormal endochondral ossification disruption at the growth plate.
Why is it called so?
The sign is named for its distinctive radiographic appearance: amorphous, coarse, and clustered calcifications composed of irregular rings and arcs that visually resemble clusters of popped corn kernels.
Pathophysiology
In chondroid lesions, the cartilaginous matrix undergoes dystrophic calcification over time; the remaining cartilage and calcific deposits form a heterogeneous pattern with coarse, rounded calcifications. In osteogenesis imperfecta, disrupted endochondral ossification results in areas of disorganized mineralization within the metaphysis and epiphyses, producing the same ‘popcorn’ appearance. In the breast, involuting fibroadenomas develop dense, coalescing calcifications due to hyalinization and sclerosis of the stroma as the lesion regresses, resulting in the classic popcorn-like pattern.
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