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Breast-nonmalignant

Benign tumors / changes

Hemangioma and angiomatosis of breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 7 October 2012, last major update April 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definitions / clinical information

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Hemangioma:

● Benign tumor or malformation of blood vessels; usually 2 cm or less

 

Angiomatosis:

● Very rare (consultation recommended before making this diagnosis); hemangioma and lymphangioma-like channels growing diffusely in breast tissue but sparing lobules and without nuclear atypia (Am J Surg Path 1985;9:652)

● Associated with smoking (Arch Dermatol 2006;142:343)

● May respond to isotretinoin (J Am Acad Dermatol 2001;45:462)

● May recur (Cancer 1988;62:2392)

 

Atypical hemangioma:

● Benign vascular lesion with nuclear pleomorphism, focal anastomosing vascular channels, microthrombi or rare mitotic figures, but no significant endothelial growth patterns of angiosarcoma (Am J Surg Pathol 1992;16:553)

● Benign behavior – if “atypical” is used in diagnosis, comment should indicate benign behavior

● FNA shows numerous atypical spindle cells in hemorrhagic background, suggesting malignancy (Diagn Cytopathol 2001;24:215)

 

Capillary hemangioma:

● Composed largely of capillary sized vessels

● Case report of 39 year old woman with capillary hemangioma and fibroadenoma (Cases J 2009 May 15;2:7005)

 

Cavernous hemangioma:

● Large dilated vessels

● Case reports of 15 cm tumor in 60 year old man (Breast Cancer 2005;12:231) and axillary tumor clinically suspicious for malignancy (South Med J 2008;101:1051)

 

Perilobular hemangioma:

● Usually 2 cm or less (Am J Surg Path 1985;9:491)

● Well circumscribed lesion composed of dilated congested capillaries in perilobular location; may have atypia with nuclear hyperchromasia, but no extensive complex anastomoses, no papillary endothelial tufting, no mitotic figures (Stanford University)

● Found at autopsy in 11% in breast (Br J Cancer 1985;51:271, Arch Pathol Lab Med 1983;107:308)

 

Venous hemangioma:

● 1-5 cm, circumscribed, disorderly proliferation of venous channels (Am J Surg Pathol 1985;9:659)

 

Treatment

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● Must completely excise any benign vascular lesion for accurate diagnosis (Stanford University)

 

Clinical images

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Diffuse dermal angiomatosis

 

Gross description (Macroscopy)

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Gross images

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Angiomatosis composed of vessels

(arrows) and breast parenchyma

 

Micro images

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Angiomatosis

                                                                               

Dilated vascular channels in breast tissue                 Anastomosing vascular channels lined

by flat endothelial cells, no smooth muscle

 

 

Diffuse dermal angiomatosis (H&E and CD31)

 

 

Atypical hemangioma

                                                                               

Cavernous hemangioma above                                      Cavernous vessels

and branching vascular channels below                     infiltrating into fat

 

 

                                                               

Branching vascular channels                                         Various images

lined by bland endothelium

 

 

Capillary hemangioma

         

 

         

Thin walled vessels of various sizes with bland endothelium

Complex branching vessels are suggestive of granuloma pyogenicum but without inflammation

 

 

Cavernous hemangioma

         

 

  

Well circumscribed with dilated vascular channels

Lobular-like pattern of dilated vessels but no anastomosing channel

Vascular spaces are lined by inconspicuous endothelium;  organizing clot with recanalization

No/rare Ki-67 staining

 

 

Perilobular hemangioma

                                                               

Thin walled vessels are congested                               Lesion in stroma is not

and extend into adjacent fat                                            associated with lobules or ducts

 

 

Atypical perilobular hemangioma

                                                                               

Compact vascular proliferation                                      Extension into fat and no distinct

associated with terminal duct                                        congested capillary channels

 

 

                                                               

Inconspicuous slit-like vascular spaces                     Hyperchromatic endothelial nuclei

lacking red blood cells

 

Virtual Slides

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Hemangioma

 

Videos

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Hemangioma of breast

 

Cytology description

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Cytology images

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Positive stains

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Negative stains

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Electron microscopy descriptions

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Electron microscopy images

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Molecular / cytogenetics description

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Molecular / cytogenetics images

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Differential Diagnosis

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Additional references

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Stanford University

 

End of Breast-nonmalignant > Benign tumors / changes > Hemangioma and angiomatosis

 

 

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