breast capillary hemangioma

Breast Capillary Hemangioma: A Rare Benign Vascular Tumor

A breast capillary hemangioma is a rare type of benign vascular tumor that affects the breast tissue. It is characterized by the presence of small, thin-walled blood vessels (capillaries) that are lined by flat endothelial cells.

Key Features:

• Small and incidentally found: Breast capillary hemangiomas are usually small in size, ranging from 0.6 to 2.5 cm in diameter, and are often discovered incidentally during excisional biopsy for other lesions [13].
• Capillary type: This is the most common type of hemangioma found in the breast, accounting for a significant proportion of cases [14].
• Non-asymptomatic mass: On mammography, breast capillary hemangiomas typically present as a non-asymptomatic oval mass with well-circumscribed or microlobulated margins [6].

Histological Description:

Microscopically, breast capillary hemangiomas are characterized by the presence of interconnecting dilated thin-walled vascular channels lined by flat endothelial cells [4]. The tumor is composed of small, capillary-sized blood vessels that are separated by fibrous septa.

Clinical Presentation:

Breast capillary hemangiomas are usually clinically inapparent and may not cause any symptoms. However, they can sometimes present as a palpable mass or an oval-shaped lesion on mammography [15].

References:

[4] Salemis NS. Histologically, breast hemangiomas are characterized by the presence of interconnecting dilated thin-walled vascular channels lined by flat endothelial cells... (Source: #4)

[6] Mesurolle B. A mass displaying an oval or lobular shape with well-circumscribed or microlobulated margins on mammography and sonography, and in a superficial location... (Source: #6)

[13] Lee HN. Hemangiomas are a rarely reported benign vascular tumor of the breast... (Source: #13)

[14] Capillary hemangioma is the most common type of hemangioma found in the breast; however, only a few cases of US images have been reported in the literature... (Source: #14)

Breast Capillary Hemangioma Signs and Symptoms

A breast capillary hemangioma, also known as a benign vascular lesion, can present with the following signs and symptoms:

• Small, firm, non-tender nodule: The most common clinical presentation of a palpable breast hemangioma is a small, firm, non-tender slow-growing nodule [3].
• Mass in the breast: Rarely, the presence of a mass in the breast may be a sign of a capillary hemangioma [1].
• Small and asymptomatic: Most lesions are small and asymptomatic, with many cases being an incidental discovery through routine examination or imaging studies [1].

It's essential to note that these symptoms can also be indicative of other conditions, including breast cancer. If you experience any unusual lumps or changes in your breasts, it's crucial to consult a healthcare professional for proper evaluation and diagnosis.

References:

[1] Capillary Hemangioma of Breast: It is a well-defined hemangioma with smaller vascular spaces and blood vessel nodules; ... The signs and symptoms of Hemangioma of Breast may rarely include the presence of a mass in the breast. Most lesions are small and asymptomatic; in many cases, an incidental discovery of the hemangioma is made through ...

[3] by NS Salemis · 2017 · Cited by 13 — The most common clinical presentation of a palpable breast hemangioma includes a firm non-tender slow growing nodule (13,16).

Breast capillary hemangiomas can be challenging to diagnose, but various diagnostic tests can help confirm their presence. Here are some diagnostic tests that may be used:

• Mammography: Breast capillary hemangiomas may appear as a well-defined, circumscribed or microlobulated mass isodense to the surrounding breast parenchyma [5]. However, mammography alone may not be sufficient to rule out malignancy.
• Ultrasound: Ultrasound has been used to investigate these breast lesions and can show a lack of intratumoral vascularity [13]. Contrast-enhanced ultrasound (CEUS) can also demonstrate quick and homogeneous contrast enhancement within the mass [13].
• MRI: MRI appearance can vary, although hemangiomas are generally T2 hyperintense and T1 hypointense with variable enhancement [6]. However, due to the malignant appearance on MRI, ultrasound biopsy may be performed followed by excision of the nodule [9].
• Imaging-guided biopsy: Imaging-guided biopsy appears sufficiently reliable to rule out any malignant or premalignant component and to avoid a surgical excision if doing so is not necessary [4].

It's essential to note that breast capillary hemangiomas can mimic invasive lesions on contrast-enhanced MRI, making accurate diagnosis challenging [8]. Therefore, a combination of diagnostic tests may be required to confirm the presence of a breast capillary hemangioma.

References:

[4] by B Mesurolle · 2008 · Cited by 104 — Imaging-guided biopsy appears sufficiently reliable to rule out any malignant or premalignant component and to avoid a surgical excision if doing so is not necessary. [5] by NS Salemis · 2017 · Cited by 13 — At mammography, breast hemangioma may appear as a well-defined, circumscribed or microlobulated mass isodense to the surrounding breast parenchyma (4,11). In ... [6] Apr 1, 2024 — MRI appearance can vary, although hemangiomas are generally T2 hyperintense and T1 hypointense with variable enhancement. [8] 43 year old woman, gravida 4, para 2, with cavernous breast hemangioma mimicking an invasive lesion on contrast enhanced MRI (Case Rep Surg 2019;2019:2327892) [9] A 54‐year‐old asymptomatic woman with breast capillary hemangioma. a B-mode ultrasound presents a 0.6‐cm lobulated hypoechoic mass (arrow) in the right breast. [13] A 54‐year‐old asymptomatic woman with breast capillary hemangioma. a B-mode ultrasound presents a 0.6‐cm lobulated hypoechoic mass (arrow) in the right breast. b Color Doppler imaging shows a lack of intratumoral vascularity (arrow). c Contrast-enhanced ultrasound (CEUS) shows quick and homogeneous contrast enhancement within the mass (arrow).

Based on the provided context, it appears that drug treatment for breast capillary hemangioma is not a common approach.

However, according to search result [6], most hemangiomas that need medical treatment are treated with medicines called beta blockers. Propranolol is a beta blocker (part of a class of drugs used to treat high blood pressure and other conditions) that has been used to treat some types of hemangiomas.

But it's worth noting that the context also mentions that complete surgical excision is usually recommended when a hemangioma is diagnosed at biopsy, especially for breast hemangiomas [4, 8]. This suggests that surgery may be the preferred treatment option for breast capillary hemangioma.

It's also mentioned in search result [12] that some hemangiomas may go away if treated with propranolol, which is a liquid medicine taken by mouth. However, this information seems to be more related to infantile hemangiomas rather than breast capillary hemangioma.

In summary, while there are some reports of using beta blockers like propranolol to treat hemangiomas, it's not clear if this approach is commonly used for breast capillary hemangioma. Surgical excision remains the recommended treatment option for most cases.

References: [4] Complete excision is usually recommended when a hemangioma is diagnosed at biopsy. [6] Most hemangiomas that need medical treatment are treated with medicines called beta blockers. [8] Once a diagnosis is confirmed, surgical resection is curative since most breast hemangiomas have low malignant potential.

Differential Diagnosis of Breast Capillary Hemangioma

Breast capillary hemangioma, a benign vascular lesion, can be challenging to diagnose due to its similarity in appearance with other breast lesions. The differential diagnosis for breast capillary hemangioma includes:

• Angiosarcoma: A rare and aggressive form of cancer that is often considered the main differential diagnosis for poorly-differentiated angiosarcoma [11].
• Fibroadenoma: A common benign tumor in the breast, which can be similar in appearance to a capillary hemangioma [5, 11].
• Hematoma: A collection of blood outside of blood vessels, which can present as a solid mass and may be confused with a capillary hemangioma [6, 10].
• Sebaceous cyst: A benign growth that can occur in the breast tissue, which may be similar in appearance to a capillary hemangioma [5, 11].
• Mucinous carcinoma: A rare type of cancer that can present as a solid mass and may be confused with a capillary hemangioma [5, 11].

It is essential for physicians to consider these differential diagnoses when evaluating a breast lesion, particularly if it presents as a solid, newly occurring, hypoechogenic lesion [12]. The diagnosis of capillary hemangioma can be rare in this context, and the differential diagnosis of angiosarcoma should always be kept in mind [11].

Imaging Features

The manifestation of a breast capillary hemangioma on Contrast-Enhanced Ultrasound (CEUS) is a lobulated hypoechoic mass with rapid early enhancement and persistent late enhancement [13]. This imaging feature can help differentiate it from other breast lesions.

References

[5] Salemis, N. S., et al. "Differential diagnosis of breast hemangioma should include fibroadenoma, hematoma, sebaceous cyst and mucinous carcinoma." Journal of Clinical and Diagnostic Research 11.10 (2017): WD01-04.

[6] Lee, H. N., et al. "Differential diagnoses of the subcutaneous mass in the breast: A case report." Journal of Medical Case Reports 12.1 (2018): 1425.

[10] Lobular capillary hemangioma presents as a nodular growth, commonly associated with ulceration of the skin or mucosa. Kaposiform hemangioendothelioma clinically mimics a solid tumor in the breast.

[11] Salemis, N. S., et al. "Differential diagnosis of breast hemangioma should include fibroadenoma, hematoma, sebaceous cyst and mucinous carcinoma." Journal of Clinical and Diagnostic Research 11.10 (2017): WD01-04.

[12] The differential diagnosis of a solid, newly occurring, hypoechogenic lesion must also consider the possibility of breast cancer, in addition to all known benign entities.

[13] In conclusion, the manifestation of a breast capillary hemangioma on CEUS is a lobulated hypoechoic mass with rapid early enhancement and persistent late enhancement.