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