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PubMed Search: Hemangioma [title] breast
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Hemangioma
- 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)
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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)
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Angiomatosis
- 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)
- 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
- In general, benign vascular tumors of breast are extremely rare
- Exception: autopsy studies have reported a higher incidence of perilobular hemangioma, approximately 11% (Arch Pathol Lab Med 1983;107:308, Br J Cancer 1985;51:271)
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Normal arterial and venous anatomy of the breast
- Painless mass in breast or incidental mass lesion on imaging
- Biopsy or excision
- Hemangioma: lobulated mass with well circumscribed or microlobulated borders, variable internal echotexture and variable calcifications
- Difficult to differentiate from fibroadenoma or complex cysts
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Fig 2: Vessels converging in medial and lateral margins
Fig 14a and 14b: Hemangiomas appear as superficially located oval with circumscribed or microlobulated borders
- Can recur; no metastasis reported
- 18 year old woman with breast angiomatosis (J Clin Diagn Res 2012;6:709)
- 33 year old woman with breast hemangioma (J Clin Imaging Sci 2012;2:53)
- 39 year old woman with breast capillary hemangioma and fibroadenoma (Cases J 2009;2:7005)
- 52 year old woman with fine needle aspiration of atypical hemangioma of breast (Diagn Cytopathol 2001;24:215)
- 53 year old woman with diffuse dermal angiomatosis of the breast and correlation with smoking (Arch Dermatol 2006;142:343)
- 60 year old man with a 15 cm caveronous hemangioma of the breast (Breast Cancer 2005;12:231)
- A young woman with diffuse dermal angiomatosis of breast, response to isotretinoin treatment (J Am Acad Dermatol 2001;45:462)
- Premenopausal woman with large cavernous hemangioma of the axilla mimicking malignancy (South Med J 2008;101:1051)
- Three patients with breast angiomatosis (Am J Surg Pathol 1985;9:652)
- Four patients with venous hemangioma of the breast (Am J Surg Pathol 1985;9:659)
- Complete excision
Contributed by Dr. Mark R. Wick
Capillary hemangioma, breast skin
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Diffuse dermal angiomatosis
AFIP images
Angiomatosis composed of vessels and breast parenchyma
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Soft tissue mass with smooth external surface
Cut surface shows congestion and slit like areas
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Hemangioma
- 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
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Angiomatosis
- 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
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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
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AFIP images
Angiomatosis
Dilated vascular channels in breast tissue
Anastomosing
vascular channels,
flat endothelial cells,
no smooth muscle
Atypical hemangioma
Cavernous vessels infiltrating into fat
Branching
vascular channels
lined by bland
endothelium
Cavernous
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
congested
capillary channels
Compact vascular
proliferation
associated with
terminal duct
Contributed by Dr. Mark R. Wick
Epithelioid
Lobular capillary
Tufted
Venous
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Angiomatosis
Hemangioma (black arrows), breast ducts and lobules
Abnormal vascular spaces in the hemangioma
Fig 14c: hemangioma
Dilated vascular and lymphatic spaces
Vascular and lymphatic spaces lined by endothelial cells
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
Histopathology breast, soft tissue - hemangioma
- Angiosarcoma (for highly pleomorphic atypical hemangioma) has solid areas, mitotic activity, infiltrative pattern of growth and complex anastomosing vascular channels
- 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?
- Excision
- Lumpectomy with hormone receptor analysis for further treatment
- Lumpectomy with radiation
- No further treatment needed
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Reference: Hemangioma and angiomatosis of breast
