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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Hemangioma of the Breast

Definition

  • Benign vascular lesion of the breast large enough to be detected clinically

Alternate/Historical Names

  • Atypical hemangioma
  • Capillary hemangioma
  • Cavernous hemangioma
  • Venous hemangioma

Diagnostic Criteria

  • By definition, detectable by palpation or mammography
    • Rarely over 2 cm
  • Grossly circumscribed
    • May merge microscopically with surrounding tissue
    • Does not invade and destroy lobules
  • Most are cavernous
    • Less frequently capillary type
  • Anastomoses infrequent, not complex
  • Fibrous septa divide lesion into lobules
    • Stroma may calcify
  • Large feeder vessels may be seen at periphery
  • Atypical hemangioma has features as above but with:
    • Increased anastomoses, or
    • Cytologic atypia
  • Venous hemangioma
    • Dilated channels
    • Walls contain smooth muscle at least partially
    • May be considered a vascular malformation
  • Complete excision and examination is required for the diagnosis of any benign vascular lesion in the breast

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting:: May 27, 2006

Supplemental studies

Immunohistology

  • Supplemental stains not typically required

Differential Diagnosis

Angiosarcoma of the Breast Hemangioma of the Breast
Diffuse Circumscribed
Infiltrates and destroys lobules Adjacent to or surrounds lobules
Rarely <2 cm Rarely >2 cm
No fibrous septa Fibrous septa forming lobules of angioma
No feeder vessels May have feeder vessels
Complex anastomoses Few anastomoses, not complex
Intermediate and high grade tumors are cytologically atypical Focal atypia at most
Frequent papillae or tufting No papillae or tufting
May have hemorrhage and necrosis No hemorrhage or necrosis
No muscular walls Venous hemangioma may have muscular walls
Complete excision and examination are required to insure accurate diagnosis of an apparently benign vascular lesion in the breast

 

Hemangioma Pseudoangiomatous Stromal Hyperplasia
Endothelial lined spaces No true lining to spaces
CD31 positive CD31 negative
Red blood cells in some spaces No red blood cells in spaces

 

Angiomatosis Perilobular Hemangioma Hemangioma Venous Hemangioma
Mass lesion Microscopic, incidental lesion Mass lesion Mass lesion
Diffuse, infiltrating Localized Localized Localized
Cavernous Predominantly capillary Usually cavernous Cavernous
Complete excision and examination is required for the diagnosis of any benign vascular lesion in the breast

Clinical

  • No evidence of aggressive behavior
    • Includes atypical lesions as defined here

Grading / Staging / Report

Grading / Staging

  • Not applicable

Report

  • If the diagnosis of a benign vascular lesion is made on a partial excision, it must be stated to be contingent upon complete excision

Lists

Breast Tumors with Vascular (and Pseudovascular) Differentiation

Bibliography

  • Rosen PP, Oberman HA. Tumors of the Mammary Gland, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 7, 1993
  • Jozefczyk MA, Rosen PP. Vascular tumors of the breast. II. Perilobular hemangiomas and hemangiomas. Am J Surg Pathol. 1985 Jul;9(7):491-503.
  • Hoda SA, Cranor ML, Rosen PP. Hemangiomas of the breast with atypical histological features. Further analysis of histological subtypes confirming their benign character. Am J Surg Pathol. 1992 Jun;16(6):553-60.
  • Rosen PP, Jozefczyk MA, Boram LH. Vascular tumors of the breast. IV. The venous hemangioma. Am J Surg Pathol. 1985 Sep;9(9):659-65.
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