Our 20-Year Institutional Experience with Surgical Approach for Breast Hamartomas

Giant Myoid mammary hamartoma: A case report

ABSTRACT

Mammary hamartoma are rare neoplasms of the breast. Myoid mammary hamartoma are a subtype comprising of prominent smooth muscle component along with normal breast tissue components including fibrous, adipose, and glandular tissue. We report the case of a 38-year-old lady who presented with a large 21 × 15 cm, firm, mobile lump in right breast, clinically mimicking as phyllodes tumor. The lesion was reported as BIRADS 4a on mammography. Fine needle aspiration cytology suggested benign breast disease. Wide local excision was performed. The excised lump was solid, gray-white with fatty yellowish areas. Histological features were of myoid mammary hamartoma. To the best of our knowledge, this is the largest myoid hamartoma reported till date. Fine needle aspiration, needle biopsy, and immunohistochemistry are of limited value as diagnostic modalities in these lesions. Complete surgical excision, proper identification, and follow-up is essential, as these lesions, more commonly those which are incompletely excised, can recur.

Breast Hamartoma: Clinical, Radiological, and Histopathological Evaluation

Objective

Breast hamartomas are rare, benign, and slow-growing breast tumors that can be definitively diagnosed by combining the results of clinical, radiological, and histopathological examination. This study aimed to evaluate the clinical, radiological, and histopathological features of hamartomas and summarize our clinical approach to hamartomas.

Materials and Methods

Patients diagnosed with breast hamartoma between 2010 and 2020 in our clinic were retrospectively analyzed. Demographic information, clinical examination, radiological findings, histopathological features, changes during follow-up, and follow-up data were obtained and analyzed.

Results

Of the 1,429 patients operated on in our clinic for benign breast diseases between January 2010 and March 2020, 39 (2.7%) were diagnosed with breast hamartomas with histopathological examination. All patients were women with a median age of 37 (19-62) years. Most of the patients (64%) were in the premenopausal period. Radiological examinations were conducted using mammography (66%), breast ultrasonography (100%), and breast magnetic resonance imaging (48%). Biopsy was performed in 14 preoperative patients, and nine (64%) patients were diagnosed with hamartoma. All patients were operated on; 37 patients underwent a lumpectomy, and two had a mastectomy. No patients had hamartoma recurrence during an average follow-up period of 39 months.

Conclusion

Hamartomas are similar to other benign breast pathologies. Definitive diagnosis can be achieved by combining the results of clinical, radiological, and histopathological examination. Given its similar composition to normal breast tissue, hamartoma has a low rate of malignancy. Definitive diagnosis and appropriate surgical treatment are required.

Breast hamartoma: reassessment of an underrecognized breast lesion

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.

Mammary hamartoma: is ultrasound-guided vacuum-assisted breast biopsy sufficient for its treatment?

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.

Imaging of male breast disease: the good, the bad and the ugly - A pictorial review

The male breast is affected by a broad spectrum of conditions, ranging from benign to malignant, many of which are similar to those occurring in its female counterpart. Despite the challenge motivated by different imaging characteristic features, correct imaging interpretation in male breast disease may aid at differentiation between benign and suspected conditions, narrow the differential diagnosis and guide subsequent management. The purpose of this review is to showcase a wide array of male breast diseases, discuss their imaging presentations and key features for diagnosis.