Other benign tumors


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PubMed Search: Hemangioma [title] breast

Monika Roychowdhury, M.D.
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Cite this page: Roychowdhury M. Hemangioma. website. Accessed July 5th, 2022.
Definition / general
  • Benign tumor or malformation of blood vessels (vascular malformation), well circumscribed, lined by flattened endothelial cells with no cytologic atypia
  • Origin from large nonneoplastic "feeding" vessels may be seen at the periphery of the lesion
  • May be divided in following categories:
    • Capillary (composed of capillary sized vessels)
    • Cavernous (large dilated vessels)
    • Venous (1 - 5 cm, proliferation of venous channels)
    • Perilobular (2 cm or less, perilobular location, may have nuclear pleomorphism and hyperchromasia but no complex anastomoses, no endothelial tufting, no mitotic figures) (Am J Surg Pathol 1985;9:491)

    Atypical Hemangioma
  • Nuclear pleomorphism; may have focal anastomosing vascular channels, microthrombi or rare mitotic figures but no significant solid areas, no necrosis, no hemorrhage, no endothelial growth patterns of angiosarcoma; has benign behavior, which should be indicated in report in comment section (Am J Surg Pathol 1992;16:553)

  • Very rare (consultation recommended before making this diagnosis); associated with smoking, may recur after excision
  • Hemangioma and lymphangioma-like channels growing diffusely in breast tissue but sparing lobules and without nuclear atypia
  • May respond to isotretinoin (see Case reports below)
Essential features
  • All age groups, mass-like lesion on imaging
  • Well circumscribed nodule composed of vascular channels lined by flattened endothelial cells
  • Size of the vascular channels may vary, however, no complex anastomotic channels, solid areas, mitotic activity, necrosis or hemorrhage (excluding biopsy related change) should be seen
  • Involves breast stroma but does not invade lobules or ducts
  • Atypical hemangioma can have mild to moderate cytologic atypia and rare mitosis but no necrosis, hemorrhage or solid areas
  • Angiomatosis shows diffuse growth (but not infiltrative) but otherwise benign cytologic features
  • Diferential diagnosis: lymphangioma (for hemangioma) and angiosarcoma (for atypical hemangioma)
  • Excision is the treatment of choice
Diagrams / tables

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Normal arterial and venous anatomy of the breast

Clinical features
  • Painless mass in breast or incidental mass lesion on imaging
  • Biopsy or excision
Radiology description
  • Hemangioma: lobulated mass with well circumscribed or microlobulated borders, variable internal echotexture and variable calcifications
  • Difficult to differentiate from fibroadenoma or complex cysts
Radiology images

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Fig 2: Vessels converging in medial and lateral margins

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Fig 14a and 14b: Hemangiomas appear as superficially located oval with circumscribed or microlobulated borders

Prognostic factors
  • Can recur; no metastasis reported
Case reports
  • Complete excision
Clinical images

Contributed by Dr. Mark R. Wick

Capillary hemangioma, breast skin

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Diffuse dermal angiomatosis

Gross images

AFIP images
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Angiomatosis composed of vessels and breast parenchyma

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Soft tissue mass with smooth external surface

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Cut surface shows congestion and slit like areas

Microscopic (histologic) description
  • Well circumscribed lesion with dilated vascular channels containing red blood cells and lined by flat endothelial cells
  • Does not invade or destroy the lobules
  • Cytologic atypia, hemorrhage and necrosis are absent

  • Diffuse growth of large irregular vascular spaces lined by flattened endothelial cells without a muscular wall, with or without luminal red blood cells
  • Surrounds breast ducts and lobules without invading them
  • No cytologic atypia seen
  • Can have lymphatic channels

    Atypical hemangioma
  • Vascular proliferation with endothelial hyperplasia, nuclear pleomorphism, anastomotic channels, microthrombi and rare mitotic figures
  • Absence of destructive invasion, solid areas, hemorrhage and necrosis are important in differentiating from angiosarcoma
Microscopic (histologic) images

Scroll to see all images:

AFIP images


Dilated vascular channels in breast tissue

vascular channels,
flat endothelial cells,
no smooth muscle

 Atypical hemangioma

Cavernous vessels infiltrating into fat

vascular channels
lined by bland

hemangioma above
and branching vascular
channels below

Capillary hemangioma

Thin walled vessels of various sizes with
bland endothelium and 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 Ki67 staining

Perilobular hemangioma

Lesion in stroma is not lobules or ducts

Thin walled vessels
are congested
and extend into
adjacent fat

 Atypical perilobular hemangioma

Inconspicuous slit-like vascular spaces lacking red blood cells

Hyperchromatic endothelial nuclei

Extension into fat
and no distinct
capillary channels

Compact vascular
associated with
terminal duct

Contributed by Dr. Mark R. Wick


Lobular capillary



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Hemangioma (black arrows), breast ducts and lobules

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Abnormal vascular spaces in the hemangioma

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Fig 14c: hemangioma

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Dilated vascular and lymphatic spaces

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Vascular and lymphatic spaces lined by endothelial cells

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Breast acini not involved by the vascular growth

Angiomatosis: diffuse dermal angiomatosis (H&E and CD31)

Capillary hemangioma

Thin walled vessels of various sizes with bland endothelium and complex branching vessels are suggestive of granuloma pyogenicum but without inflammation

Positive stains
Negative stains

Histopathology breast, soft tissue - hemangioma
Differential diagnosis
  • Angiosarcoma (for highly pleomorphic atypical hemangioma) has solid areas, mitotic activity, infiltrative pattern of growth and complex anastomosing vascular channels
Board review style question #1
    A 54 year old woman had a breast lump. A stereotactic biopsy showed vascular channels lined by mildly pleomorphic endothelial cells and rare mitotic activity, however, no solid areas or necrosis was seen. What is the best treatment recommendation for this patient?

  1. Excision
  2. Lumpectomy with hormone receptor analysis for further treatment
  3. Lumpectomy with radiation
  4. No further treatment needed
Board review style answer #1
A. This is an atypical hemangioma. Excision is adequate treatment.

Comment here

Reference: Hemangioma and angiomatosis of breast
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