Definition

• Benign microscopic vascular lesion of the breast

Alternate/Historical Names

• Atypical perilobular hemangioma

Diagnostic Criteria

• Incidental microscopic lesion
• Frequently within the lobular stroma
  • May involve extralobular or periductal stroma
• Cluster of vascular channels
  • Capillary to small cavernous vessels
• Usually no cytologic atypia
• Occasional lesions with atypical features
  • May have focal anastomoses
  • May have hyperchromatic nuclei
  • Must lack extensive complex anastomoses, papillary endothelial tufting, mitotic figures
• 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
• Pseudoangiomatous stromal hyperplasia
• Other benign vascular lesions of the breast

Angiosarcoma of the Breast	Perilobular Hemangioma
Almost always a hemorrhagic mass >2 cm	Microscopic, incidental lesion
Diffuse, infiltrating	Localized
Complex anastomoses	No complex anastomoses
Intermediate and high grade tumors are cytologically atypical	No significant cytologic atypia
Frequent papillae or tufting	No papillae or tufting

Complete excision and examination are required to insure accurate diagnosis of an apparently benign vascular lesion in the breast

 

Perilobular 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

Both are usually incidental findings

 

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 or malignant behavior
  • Includes atypical lesions as defined

Report

If the diagnosis is made on a partial excision, it must be stated to be contingent upon complete excision

Lists

Breast Tumors with Vascular (and Pseudovascular) Differentiation

• Angiomatosis
• Angiosarcoma
• Hemangioma
• Perilobular Hemangioma
• Post-irradiation Atypical Vascular Lesion (skin of breast)
• Venous Hemangioma
• (Pseudoangiomatous stromal hyperplasia)

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
• Lesueur GC, Brown RW, Bhathal PS. Incidence of perilobular hemangioma in the female breast. Arch Pathol Lab Med. 1983 Jun;107(6):308-10
• Rosen PP, Ridolfi RL. The perilobular hemangioma. A benign microscopic vascular lesion of the breast. Am J Clin Pathol. 1977 Jul;68(1):21-3.