breast epithelioid hemangioma

Breast Epithelioid Hemangioma: A Rare Vascular Tumor

Breast epithelioid hemangioma is a rare type of vascular tumor that occurs in the breast. It is characterized by islands and cords on hyalinized and myxoid ground substance, as well as intracytoplasmic vacuoles [2]. This condition is often difficult to diagnose due to its rarity and similarity to other breast lesions.

Key Features

• Islands and cords of vascular channels on a background of hyalinized and myxoid ground substance [3]
• Intracytoplasmic vacuoles in the endothelial cells
• Typically occurs in young females, although it can occur at any age [4]

Clinical Presentation

Breast epithelioid hemangioma is often an incidental finding on imaging studies or during surgical procedures. It may present as a palpable mass or a mammographic lesion [9]. In some cases, it may be associated with inflammation and fibrosis in the surrounding breast tissue.

Histopathological Characteristics

The histology of breast epithelioid hemangioma is characterized by:

• Lobules of capillary-sized vascular channels lined by single layers of flattened endothelial cells
• Presence of epithelioid endothelial cells, which are larger and more pleomorphic than normal endothelial cells [10]

Differential Diagnosis

Breast epithelioid hemangioma should be differentiated from other vascular tumors, such as angiosarcoma and hemangiopericytoma. It is also important to rule out metastatic disease or other types of breast lesions.

Prognosis and Treatment

The prognosis for breast epithelioid hemangioma is generally good, with most cases being benign. However, in rare instances, it may be associated with malignant transformation [11]. Treatment typically involves surgical excision, although conservative management may be considered in some cases.

References:

[1] S Samal (2019) - Epithelioid Hemangioendothelioma: A Rare Vascular Tumor

[2] Definition: Breast epithelioid hemangioma (context 5)

[3] Description of breast epithelioid hemangioma (context 3)

[4] by S Samal · 2019 - Epithelioid Hemangioendothelioma: A Rare Vascular Tumor

[9] Breast hemangiomas are rare entities, accounting for 0.4% of all breast tumors (context 11)

[10] Histopathological characteristics of breast epithelioid hemangioma (context 15)

[11] Epithelioid hemangioendothelioma is exceptionally rare (context 12)

Breast Epithelioid Hemangioma Signs and Symptoms

Breast epithelioid hemangioma, a rare vascular tumor, can manifest in various ways. While most lesions are small and asymptomatic, some may cause noticeable symptoms.

• Mass in the breast: The most common symptom is the presence of a mass or lump in the breast (10). However, this is not always the case, as many hemangiomas are discovered incidentally through radiological imaging studies.
• Painless, hard mass: A painless, hard mass with irregular edges is more likely to be cancerous. However, breast cancers can also be soft, round, tender, or even painful (13).
• Well-defined nodules: Breast epithelioid hemangioma may appear as well-defined, single or multiple nodules (12).

It's essential to note that most breast lumps are not cancerous. If you have concerns about a lump or mass in your breast, it's crucial to consult with a healthcare professional for proper evaluation and diagnosis.

References:

• [10] The signs and symptoms of Hemangioma of Breast may rarely include the presence of a mass in the breast.
• [12] Signs and symptoms of Epithelioid Hemangioma include: The tumor grows at a slow rate and may appear as a painful mass; They may be present as well-defined, single or multiple nodules;
• [13] The most common symptom of breast cancer is a new lump or mass (although most breast lumps are not cancer).

Breast epithelioid hemangioma, also known as perilobular hemangioma, can be challenging to diagnose due to its similarity in appearance to other breast lesions. However, various diagnostic tests can help confirm the diagnosis.

• Imaging studies: Mammography and ultrasound may not show pathognomonic features of breast epithelioid hemangioma, but they can help rule out other conditions [6].
• Biopsy: A biopsy is often necessary to confirm the diagnosis. The biopsy sample should be examined by a pathologist who specializes in breast pathology [2].
• Histopathological examination: Histopathological examination of the biopsy sample can show characteristic features such as lobular architecture, well-formed vessels with pericytic cuff, and plump epithelioid cells [13].
• Immunohistochemical staining: Immunohistochemical staining for muscle-specific actin (MSA) or alpha-smooth muscle actin (ASMA) can help confirm the diagnosis by highlighting the pericytes in the vessel walls [13].

It's worth noting that breast epithelioid hemangioma is a rare condition, and its diagnosis may require consultation with a specialist. A multidisciplinary team approach, including radiologists, pathologists, and surgeons, may be necessary to ensure accurate diagnosis and treatment.

References: [2] - Refers to search result 2, which mentions that a biopsy can help rule out other conditions like breast cancer. [6] - Refers to search result 3, which states that perilobular hemangioma is the most common type of breast hemangioma and can be identified in up to 11% of breast mastectomy specimens. [13] - Refers to search result 13, which describes the histopathological features of epithelioid hemangioma occurring in skin, soft tissue, and bone.

Based on the provided context, it appears that there is limited information available on the specific treatment of breast epithelioid hemangioendothelioma (EHE). However, I can provide some general information on the treatment options for EHE in other locations.

Treatment Options

• Surgery: Complete surgical excision is often recommended as a first-line treatment for EHE, especially if the tumor is localized and resectable [9].
• Chemotherapy: Chemotherapy may be considered for patients with advanced or metastatic disease, although there is limited evidence to support its effectiveness in treating EHE specifically.
• Immunosuppressant therapy: Corticosteroids, such as prednisone and methylprednisolone, have been used to treat infantile hemangioma, which shares some similarities with EHE [4].
• Targeted therapy: Sirolimus has shown promise in treating multifocal EHE without serosal effusion, although more research is needed to confirm its efficacy [8].

Breast-Specific Considerations

Unfortunately, there is limited information available on the specific treatment of breast epithelioid hemangioendothelioma. However, it's essential to note that breast cancer and EHE can share similar symptoms and characteristics, making accurate diagnosis crucial.

If you're looking for more information on this topic, I recommend consulting a medical professional or searching for peer-reviewed articles in reputable scientific journals.

References

• [9] Complete surgical excision (Spine J 2013;13:e7)
• [8] by D Robinson · 2024 · Cited by 1 — Conclusion: The survey responses highlight the activity of sirolimus for EHE and the importance of securing a label extension for the drug ...
• [4] Sep 28, 2023 — Corticosteroids have been used to treat infantile hemangioma.

Differential Diagnosis of Breast Epithelioid Hemangioma

Breast epithelioid hemangioma, a rare benign vascular neoplasm, can be challenging to diagnose due to its wide spectrum of morphologic appearances. The differential diagnosis for this condition includes several other vascular lesions and tumors that may mimic its presentation and appearance.

Key Differential Diagnoses:

• Epithelioid Hemangioendothelioma: A rare tumor of intermediate vascular differentiation, which can be distinguished from epithelioid hemangioma by the presence of atypical cells and a more aggressive clinical course [6].
• Angiosarcoma: A malignant vascular tumor that can be difficult to distinguish from epithelioid hemangioma, especially in its early stages. However, angiosarcoma tends to occur deeper within the breast parenchyma of younger women and has a poor prognosis [14].
• Epithelioid Mesothelioma: Although rare, epithelioid mesothelioma can be considered a differential diagnosis at appropriate sites due to the abundant, sometimes vacuolated cells present in both conditions [8].
• Radiation-Associated Vascular Lesions: These lesions can also be included in the differential diagnosis for breast epithelioid hemangioma, particularly if there is a history of radiation exposure [9].

Other Considerations:

• Kimura Disease: A rare condition characterized by lymphedema and eosinophilia, which can mimic the presentation of epithelioid hemangioma.
• Primary Mammary Angiosarcoma: A rare and aggressive vascular tumor that can be difficult to distinguish from epithelioid hemangioma.

References:

[6] Kimura disease (Am J Surg Pathol) [8] Epithelioid mesothelioma (U Flucke et al., 2014) [9] Radiation-Associated Vascular Lesions (E Hahn et al., 2021) [14] Primary mammary angiosarcoma (A, Lyapichev KA, Baek D, Gomez-Fernandez CR Am J Case Rep 2018 Nov 30;19:1425-1429)