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Alran L, Chamming's F, Auriol-Leizagoyen S, Velasco V, Deleau F, Brouste V, Bonhomme B, Ben Rejeb H, Marty M, MacGrogan G. Breast hamartoma: reassessment of an underrecognized breast lesion. Histopathology 2021; 80:304-313. [PMID: 34403159 DOI: 10.1111/his.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/29/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS Breast hamartomas are an under-recognized lesion because they lack a distinctive microscopic appearance. Microscopic diagnosis can often conclude "no significant lesion" or "normal breast tissue", leading to repeated biopsies and diagnostic delay. We describe the histological, immunohistochemical and radiological features of breast hamartomas in the aim of identifying specific signs to facilitate their diagnosis and to differentiate them from normal breast and fibroepithelial lesions. METHODS AND RESULTS: Forty-seven breast hamartomas were reassessed (histological diagnosis and imaging features). An immunohistochemical study (ER, PR, CD34, HMGA2) was performed. On breast imaging, hamartomas most often presented as probably benign solid masses with circumscribed margins and variable densities. Histologically, breast hamartomas resembled normal breast, although their stromal component was predominant, separating randomly scattered epithelial elements, with areas of pure collagenous stroma. Pseudo angiomatous stromal hyperplasia (PASH) was present in 93.6% of cases and CD34 antibody highlighted intralobular, perilobular and interlobular distribution of CD34-positive fibroblasts. By comparison, CD34 was mostly expressed in the intralobular normal breast tissue stroma. Hamartoma stromal cells expressed HMGA2, ER and PR in 79%, 66% and 76.3% of our cases, respectively, compared to 7.7%, 23% and 19% in normal breast tissue, respectively (P<0.0001; P=0.0005; P<0.0001). CONCLUSIONS After ascertaining that core needle biopsy is effectively intralesional, breast hamartomas can be diagnosed with confidence by taking into account the presence of stromal changes, PASH, interlobular distribution of CD34-positive fibroblasts, HMGA2 and hormonal receptor stromal expression.
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Affiliation(s)
- Léonie Alran
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France.,Univ. Bordeaux, F-33000, Bordeaux, France
| | - Foucauld Chamming's
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Sophie Auriol-Leizagoyen
- Department of Surgical Oncology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Valérie Velasco
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Florian Deleau
- Univ. Bordeaux, F-33000, Bordeaux, France.,Department of Radiology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Véronique Brouste
- Department of Clinical Research and Medical Information, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Benjamin Bonhomme
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Houda Ben Rejeb
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
| | - Marion Marty
- Department of Pathology, Hôpital de Haut Lévêque, Bordeaux University Hospital, F-33000, Bordeaux, France
| | - Gaëtan MacGrogan
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Centre, F-33000, Bordeaux, France
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Hu H, Zhang M, Liu Y, Li XR, Liu G, Wang Z. Mammary hamartoma: is ultrasound-guided vacuum-assisted breast biopsy sufficient for its treatment? Gland Surg 2020; 9:1278-1285. [PMID: 33224802 DOI: 10.21037/gs-20-437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Mammary hamartomas were mostly benign tumors with rare rate of recurrence and malignant transformation. Ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) has been reported sufficiently safe in treating many breast benign tumors but remained undefined in mammary hamartoma for its usual underdiagnosis in US. Thus, this study aims to evaluate the efficiency of US-guided VABB in treating mammary hamartomas. Methods From May 2015 to March 2019, 3,388 lesions of 2,534 patients underwent percutaneous US-guided VABB, among which 31 mammary hamartomas proved by pathology were included in this study. Patients were followed up by US three, six and twelve months later, then at 1-year intervals. Lesions were classified to analyze the possible factors associated with excision rate, bleeding volume and complications. Results Of the 31 patients, recurrence was seen in 1 case in 1 year after the procedure and complete excision rate was 96.8% (30/31). The bleeding volume ranged from 1 to 15 mL (mean number ± standard deviation, 6.5±3.4 mL) and significant statistical differences were detected in patient age and the largest diameter of lesions. The main complications included pain (22.6%), hematomas (9.7%) and ecchymosis (3.2%). Conclusions US-guided VABB ensures an outstanding complete excision rate and provides an alternative solution to treat mammary hamartomas.
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Affiliation(s)
- Huayu Hu
- School of Medicine, Nankai University, Tianjin, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mengke Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuan Liu
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xi-Ru Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Gang Liu
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhili Wang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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