Breast

Other benign tumors

Hemangioma


Editorial Board Member: Julie M. Jorns, M.D.
Deputy Editor-in-Chief: Gary Tozbikian, M.D.
Indu Agarwal, M.D.
Luis Blanco, Jr., M.D.

Last author update: 9 August 2022
Last staff update: 9 August 2022

Copyright: 2003-2023, PathologyOutlines.com, Inc.

PubMed Search: Hemangioma breast

Indu Agarwal, M.D.
Luis Blanco, Jr., M.D.
Page views in 2022: 4,202
Page views in 2023 to date: 458
Cite this page: Agarwal I, Blanco L. Hemangioma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breasthemangioma.html. Accessed February 8th, 2023.
Definition / general
  • Hemangioma:
    • Benign vascular lesions, microscopically well circumscribed and lacking endothelial cell atypia (Semin Diagn Pathol 2017;34:410)
    • Origination from large nonneoplastic "feeding" vessels, may be seen at the periphery of the lesion
    • The following categories are recognized:
      • Capillary (composed of compact, lobular, collections of small blood vessels)
      • Cavernous (dilated vessels filled with erythrocytes)
      • Venous (featuring vascular structures containing muscular walls of varying thickness) (Am J Surg Pathol 1985;9:659)
      • Perilobular (≤ 2 mm, capillary hemangiomas, intra or interlobular location)
  • Angiomatosis:
    • Often clinically present as large mass (9 - 22 cm)
    • Histologically benign vascular proliferation affecting a large segment of the breast
    • Lacks circumscription of hemangioma and can involve the subcutaneous tissue and skin (Am J Surg Pathol 1985;9:652, Cancer 1988;62:2392)
Essential features
  • Proliferation of well differentiated vessels of varying sizes
  • Angiomatosis shows diffuse growth of blood vessels of varying sizes that surrounds ducts / lobules but without invasion of the intralobular stroma
  • No complex anastomotic channels, cytologic atypia, cellular multilayering, solid areas, mitotic activity, necrosis or hemorrhage (blood lakes), features differentiating from angiosarcoma
Terminology
  • Acceptable: angioma
ICD coding
  • ICD-O: 9120/0 - hemangioma, NOS
  • ICD-11: 2F30.Y & XH5AW4 - other specified benign neoplasm of breast and hemangioma, NOS
Epidemiology
Sites
  • Mammary parenchyma, subcutaneous tissue or dermis
Pathophysiology
  • Unknown
Etiology
  • Nonneoplastic vascular malformations
Diagrams / tables

Images hosted on other servers:
Missing Image

Normal arterial and venous anatomy of the breast

Clinical features
Diagnosis
  • Biopsy or excision
Radiology description
  • Mostly nonpalpable, found on imaging (MRI or mammography)
  • No pathognomonic features, may show mammographic density or mass on mammogram or ultrasound, with oval or lobular shape and well circumscribed or microlobulated margins (AJR Am J Roentgenol 2008;191:W17)
Radiology images

Contributed by Indu Agarwal, M.D.
Cavernous hemangioma ultrasound

Cavernous hemangioma, ultrasound

Cavernous hemangioma mammographic

Cavernous hemangioma, mammography

Capillary hemangioma ultrasound

Capillary hemangioma, ultrasound

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

Contributed by Mark R. Wick, M.D.

Capillary hemangioma, breast skin



Images hosted on other servers:

Diffuse dermal angiomatosis

Gross description
  • Larger lesions: circumscribed red or dark-brown spongy lesion
  • Small lesions may not be appreciated grossly
  • Angiomatosis presents as a large, red, hemorrhagic, cystic, spongy mass lesion
Gross images

AFIP images
Missing Image

Angiomatosis composed of vessels / breast parenchyma



Images hosted on other servers:
Missing Image

Soft tissue mass with smooth external surface

Missing Image

Cut surface shows congestion and slit-like areas

Microscopic (histologic) description
  • Hemangioma:
    • Proliferation of well differentiated blood vessels of varying sizes, generally small (< 2 cm), usually nonanastomosing
    • Largely well circumscribed
    • Cytologic atypia, hemorrhage, mitotic activity and necrosis are absent
    • Within interlobular stroma, except in perilobular hemangioma which involves intralobular stroma
    • Perilobular hemangioma: usually incidental microscopic lesions, ≤ 2 mm, conglomerate of small, thin walled capillary vessels in and around a lobule (Am J Surg Pathol 1985;9:491)
  • Angiomatosis:
    • Proliferation of vascular channels with wide variation in caliber, diffusely growing throughout the breast with some anastomosis
    • Unencapsulated with infiltrative borders
    • No invasion of intralobular stroma
    • May extend to overlying skin (Clin Breast Cancer 2016;16:e7)
    • Absence of destructive invasion, solid areas, hemorrhage and necrosis, differentiating it from angiosarcoma
    • Low mitotic rate, Ki67 proliferation index < 2%
Microscopic (histologic) images

Contributed by Indu Agarwal, M.D. and AFIP images
Cavernous hemangioma of breast Cavernous hemangioma of breast

Cavernous hemangioma of breast

Capillary hemangioma Capillary hemangioma

Capillary hemangioma

Perilobular hemangioma Perilobular hemangioma

Perilobular hemangioma


Complex hemangioma

Complex hemangioma

Angiomatosis

Positive stains
Negative stains
Videos

Histopathology breast, soft tissue - hemangioma

Sample pathology report
  • Left breast, MRI guided core needle biopsy:
    • Breast tissue with perilobular hemangioma
Differential diagnosis
  • Angiolipoma:
    • Has intermixed adipose tissue, clusters of capillary sized vessels, some with microthrombi
  • Angiosarcoma:
    • Has solid areas, mitotic activity, infiltrative pattern of growth and complex anastomosing vascular channels
  • Atypical vascular lesion:
    • Often past history of radiation
    • Anastomosing thin walled vessels, unlike well formed vessels of hemangioma
Board review style question #1

A 58 year old woman had a 4.0 cm breast mass with overlying erythematous skin patch. A stereotactic biopsy showed the histology above. What is the best treatment recommendation for this patient?

  1. Excision with wide margins
  2. Lumpectomy with hormone therapy
  3. Lumpectomy with radiation
  4. No further treatment needed
Board review style answer #1
A. Excision with wide margins. This is an angiosarcoma with a predominantly solid appearance and the cells demonstrate nuclear atypia, unlike a hemangioma, which lacks these features. Wide excision, preferably mastectomy, should be performed.

Comment here

Reference: Hemangioma
Board review style question #2
A 35 year old woman presents with a 10 cm palpable breast mass. Core needle biopsy shows the lesion occupying the entire biopsy tissue and consisting of large, thin walled vessels lined by bland endothelial cells. The lesion surrounds but does not invade the normal breast lobular units. No cytologic atypia, necrosis, solid areas or mitotic activity is seen. The Ki67 proliferation index is 1%. What is the most likely diagnosis?

  1. Angiomatosis
  2. Angiosarcoma
  3. Cavernous hemangioma
  4. Lymphangioma
Board review style answer #2
A. Angiomatosis. This is a case of angiomatosis of breast. The lesion is large and consists of large, thin walled vessels, which lack atypia, mitosis and other malignant cytologic features, and do not invade the normal breast lobular stroma.

Comment here

Reference: Hemangioma
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