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Dhami A, Hao M, Waheed U, Dashevsky BZ, Bean GR. Breast Hemangiomas: Imaging Features With Histopathology Correlation. JOURNAL OF BREAST IMAGING 2024; 6:288-295. [PMID: 38557759 DOI: 10.1093/jbi/wbae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Indexed: 04/04/2024]
Abstract
Breast hemangiomas are rare benign vascular lesions. In a previously performed review of approximately 10,000 breast surgical pathology results, roughly 0.15% (15/~10 000) were hemangiomas. Hemangiomas are more frequent in women and have a documented age distribution of 1.5 to 82 years. They are most often subcutaneous or subdermal and anterior to the anterior mammary fascia but may rarely be seen in the pectoralis muscles or chest wall. On imaging, breast hemangiomas typically present as oval or round masses, often measuring less than 2.5 cm, with circumscribed or mostly circumscribed, focally microlobulated margins, equal or high density on mammography, and variable echogenicity on US. Calcifications, including phleboliths, can be seen. Color Doppler US often shows hypovascularity or avascularity. MRI appearance can vary, although hemangiomas are generally T2 hyperintense and T1 hypointense with variable enhancement. Pathologic findings vary by subtype, which include perilobular, capillary, cavernous, and venous hemangiomas. If core biopsy pathology results are benign, without atypia, and concordant with imaging and clinical findings, surgical excision is not routinely indicated. Because of histopathologic overlap with well-differentiated or low-grade angiosarcomas, surgical excision may be necessary for definitive diagnosis. Findings that are more common with angiosarcomas include size greater than 2 cm, hypervascularity on Doppler US, irregular shape, and invasive growth pattern.
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Affiliation(s)
- Alysha Dhami
- Breast Imaging Division, Department of Radiology, Stanford Medicine, Stanford, CA, USA
| | - Meng Hao
- Breast Imaging Division, Department of Radiology, Stanford Medicine, Stanford, CA, USA
| | - Uzma Waheed
- Breast Imaging Division, Department of Radiology, Stanford Medicine, Stanford, CA, USA
| | - Brittany Z Dashevsky
- Breast Imaging Division, Department of Radiology, Stanford Medicine, Stanford, CA, USA
| | - Gregory R Bean
- Department of Pathology, Stanford Medicine, Stanford, CA, USA
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Bancroft A, Santa Cruz J, Levett K, Nguyen QD. Incidental Breast Hemangioma on Breast MRI: A Case Report. Cureus 2024; 16:e57903. [PMID: 38725792 PMCID: PMC11079714 DOI: 10.7759/cureus.57903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Vascular tumors of the breast are rare, but benign hemangiomas are the most common type. Capillary hemangiomas are a subset of benign vascular tumors that involve smaller vessel sizes. They are difficult to diagnose with mammography and ultrasound, as they lack pathognomonic features and are frequently not seen. MRI is the most sensitive imaging tool. The lesions appear similar to angiosarcoma or ductal carcinoma in situ on imaging, which further complicates the diagnosis. A biopsy of the lesions is required for a definitive diagnosis. In this report, a 49-year-old female with newly diagnosed breast cancer is incidentally found to have a capillary hemangioma on staging breast MRI that was confirmed with a biopsy and excised along with the primary breast cancer with a partial mastectomy. The imaging findings of breast hemangioma on mammography, ultrasound, and MRI are also reviewed and described in this report.
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Affiliation(s)
| | | | - Kaitlyn Levett
- Pathology and Immunology, Baylor College of Medicine, Houston, USA
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Azam R, Mrkonjic M, Gupta A, Gladdy R, Covelli AM. Mesenchymal Tumors of the Breast: Fibroblastic/Myofibroblastic Lesions and Other Lesions. Curr Oncol 2023; 30:4437-4482. [PMID: 37232796 DOI: 10.3390/curroncol30050338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 05/27/2023] Open
Abstract
Mesenchymal breast tumors are a rare and diverse group of tumors that present some of the most challenging cases for multidisciplinary breast cancer teams. As a result of overlapping morphologies and a lack of large-scale studies on these tumors, practices are often heterogeneous and slow to evolve. Herein, we present a non-systematic review that focuses on progress, or lack thereof, in the field of mesenchymal breast tumors. We focus on tumors originating from fibroblastic/myofibroblastic cells and tumors originating from less common cellular origins (smooth muscle, neural tissue, adipose tissue, vascular tissue, etc.).
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Affiliation(s)
- Riordan Azam
- Postgraduate Medical Education, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Miralem Mrkonjic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G 1X5, Canada
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Abha Gupta
- Department of Medical Oncology, University of Toronto, Toronto, ON M5G 1X8, Canada
- The Hospital for Sick Children and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rebecca Gladdy
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Andrea M Covelli
- Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
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Sinusoidal hemangioma: Correlation Between Ultrasound and Histologic Findings in 3 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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García-Harana C, Fernandez-Canedo I, Rodriguez-Lobalzo S, Repiso Jiménez JB. Sinusoidal Hemangioma: Correlation Between Ultrasound and Histologic Findings in 3 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2019; 111:181-183. [PMID: 31421819 DOI: 10.1016/j.ad.2018.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/05/2018] [Accepted: 06/24/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- C García-Harana
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España.
| | - I Fernandez-Canedo
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
| | - S Rodriguez-Lobalzo
- Servicio de Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, España
| | - J B Repiso Jiménez
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
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de Mello Tucunduva TC, Gaziero A, Tostes VS, Stiepcich MMA, Torres US, Ohara P, Andrade WP, Ferreira AHPG, Missrie DR, de Mello GGN. Cavernous Hemangioma Between the Elastomer and Fibrous Capsule of a Breast Implant. Aesthetic Plast Surg 2018; 42:1257-1260. [PMID: 29872905 DOI: 10.1007/s00266-018-1153-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/05/2018] [Indexed: 11/25/2022]
Abstract
Hemangiomas are described in many locations, but breast hemangioma (BH) is rare, accounting for only 0.4% of all breast tumors. These tumors are difficult to diagnose preoperatively using conventional imaging modalities because they lack pathognomonic characteristics. Mammographic and sonographic appearances of BH were described in just a few case reports, and breast implant-related hemangiomas are even rarer. We report a case of the tumor arising in an atypical location-between the elastomer and fibrous capsule of a breast implant.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Antonio Gaziero
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-910, Brazil
| | | | | | - Ulysses S Torres
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-910, Brazil.
| | - Patricia Ohara
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP, 01333-910, Brazil
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Díaz-Flores L, Gutiérrez R, González-Gómez M, García P, Sáez FJ, Díaz-Flores L, Carrasco JL, Madrid JF. Segmentation of Dilated Hemorrhoidal Veins in Hemorrhoidal Disease. Cells Tissues Organs 2018; 205:120-128. [PMID: 29913446 DOI: 10.1159/000489250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/08/2018] [Indexed: 12/21/2022] Open
Abstract
Vein segmentation is a vascular remodeling process mainly studied in experimental conditions and linked to hemodynamic factors, with clinical implications. The aim of this work is to assess the morphologic characteristics, associated findings, and mechanisms that participate in vein segmentation in humans. To this end, we examined 156 surgically obtained cases of hemorrhoidal disease. Segmentation occurred in 65 and was most prominent in 15, which were selected for serial sections, immunohistochemistry, and immunofluorescence procedures. The dilated veins showed differently sized spaces, separated by thin septa. Findings associated with vein segmentation were: (a) vascular channels formed from the vein intima endothelial cells (ECs) and located in the vein wall and/or intraluminal fibrin, (b) vascular loops formed by interconnected vascular channels (venous-venous connections), which encircled vein wall components or fibrin and formed folds/pillars/papillae (FPPs; the encircling ECs formed the FPP cover and the encircled components formed the core), and (c) FPP splitting, remodeling, alignment, and fusion, originating septa. Thrombosis was observed in some nonsegmented veins, while the segmented veins only occasionally contained thrombi. Dense microvasculature was also present in the interstitium and around veins. In conclusion, the findings suggest that hemorrhoidal vein segmentation is an adaptive process in which a piecemeal angiogenic mechanism participates, predominantly by intussusception, giving rise to intravascular FPPs, followed by linear rearrangement, remodeling and fusion of FPPs, and septa formation. Identification of other markers, as well as the molecular bases, hemodynamic relevance, and possible therapeutic implications of vein segmentation in dilated hemorrhoidal veins require further studies.
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Affiliation(s)
- Lucio Díaz-Flores
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - Ricardo Gutiérrez
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - Miriam González-Gómez
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - Pino García
- Department of Pathology, Hospiten, Santa Cruz, Spain
| | - Francisco J Sáez
- Department of Cell Biology and Histology UFI11/44, School of Medicine and Dentistry, University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Lucio Díaz-Flores
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - José Luis Carrasco
- Department of Basic Medical Sciences, Faculty of Medicine, University of La Laguna, La Laguna, Spain
| | - Juan F Madrid
- Department of Cell Biology and Histology, School of Medicine, University of Murcia, Murcia, Spain
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Díaz-Flores L, Gutiérrez R, García MP, González-Gómez M, Sáez FJ, Díaz-Flores L, Carrasco JL, Madrid JF. Sinusoidal hemangioma and intravascular papillary endothelial hyperplasia: Interrelated processes that share a histogenetic piecemeal angiogenic mechanism. Acta Histochem 2018; 120:255-262. [PMID: 29486986 DOI: 10.1016/j.acthis.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 12/12/2022]
Abstract
Sinusoidal hemangioma, characterized by interconnecting thin-walled vascular spaces, may present papillae/pseudo-papillae and zones that resemble intravascular papillary endothelial hyperplasia (IPEH). Our objectives are to explore the existence of zones in IPEH with sinusoidal hemangioma characteristics, the mechanism of papillary and septa formation in sinusoidal hemangioma and the comparison of this mechanism with that in IPEH. For these purposes, specimens of 4 cases of each entity were selected and studied by serial histologic sections and by immunochemistry and immunofluorescence procedures. The results showed a) zones with characteristics of sinusoidal hemangioma in IPEH cases, b) presence in both entities of papillae with a cover formed by a monolayer of CD34+ and CD31+ endothelial cells (ECs) and a core formed by either type I collagen and αSMA+ cells (presenting a pericyte/smooth muscle cell aspect) or thrombotic components, and c) a similar piecemeal angiogenic mechanism in papillary formation, including sprouting of intimal ECs toward the vessel wall itself or intravascular thrombi, formation of vascular loops that encircle and separate vessel wall or thrombus components, and parietal or thrombotic papillae development. The major differences between both entities were the number, arrangement and substrate of papillae: myriad, densely grouped, parietal and thrombotic papillae in IPEH, and a linear arrangement of predominant parietal papillae in sinusoidal hemangioma, originating septa (segmentation). In conclusion, sinusoidal hemangioma and IPEH are interrelated processes, which share morphologic findings and a piecemeal angiogenic mechanism, combining sprouting and intussusceptive angiogenesis, and leading to papillary formation and vessel segmentation.
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