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

Perilobular Hemangioma of the Breast

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 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

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.
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