Breast hemangioma

The mammographic mass has a circumscribed margin, most suggestive of a cyst. However, it has increased in size since the prior study and there are no other visible circumscribed masses in either breast (ie(i.e. appearance does not fit the "multiple bilateral masses" category^1,2) - hence prompting further assessment.

At ultrasound, it was subtle, near isoechoic and superficial.

Both the mammogram and ultrasound appearances are compatible with a haemangioma, however given the relative infrequency of this diagnosis, other differentials would generally be considered first.

There is a subtle, near iso-echoic circumscribed mass in the right breast 6o'c 3cm FN6 o'clock 3 cm from nipple, without internal flow on Doppler assessment.

This corresponds to the mammographic lesion shown above.

US guided-guided core biopsy pathology report:

Richly vascularised lesion, 4mm across, circumscribed edges. Variably sized crowded capillary vessesvessels and cavernuoscavernous vascular spaces are seen, in part with intraluminal RBCs and occasional mononuclear leucocytes. The intervening stroma is minimally edematous and fibrous. There is no solid endothelial proliferation, necrosis or pseudopapillary hyperplasia. 

There is no complex infiltrative pattern, cytological atypia or mitotic activity.

Comment:

The sharp circumscription and lack of atypical features favours a benign haemangioma. 

The possibility of angiosarcoma should be considered with any vascular lesion of the breast, requiring clinical and radiological correlation.