Vascular Tumors of the Breast: Mammographic, Sonographic, and MRI Appearances
Katrina N. Glazebrook1,
Marilyn J. Morton1 and
Carol Reynolds2
1 Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN
55905.
2 Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905.
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Fig. 1A. —56-year-old woman with palpable mass in inferior aspect of
left breast. Magnified mediolateral oblique mammogram shows well-circumscribed
superficial nodule.
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Fig. 1B. —56-year-old woman with palpable mass in inferior aspect of
left breast. Sonogram obtained in area of palpable mass shows 1-cm lesion that
is poorly defined and mildly echogenic compared with adjacent adipose tissue.
Mass (arrow) lies superficial to anterior layer of superficial
pectoral fascia. Excisional biopsy confirmed mass to be hemangioma.
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Fig. 2A. —53-year-old woman with superficial mass in left breast that
had been present for 30 years but had recently been enlarging. Mediolateral
oblique mammogram shows well-circumscribed lobulated superficial mass in upper
part of breast.
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Fig. 2B. —53-year-old woman with superficial mass in left breast that
had been present for 30 years but had recently been enlarging. Sonogram shows
heterogeneous, ill-defined, superficial, lobulated mass.
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Fig. 2C. —53-year-old woman with superficial mass in left breast that
had been present for 30 years but had recently been enlarging. On color
Doppler sonogram, hypoechoic cystic-appearing spaces do not show any blood
flow, although large draining vein at periphery was identified on color
Doppler and Doppler interrogations.
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Fig. 2D. —53-year-old woman with superficial mass in left breast that
had been present for 30 years but had recently been enlarging. Photograph of
cross-section of pathologic specimen shows circumscribed, lobulated,
hemorrhagic mass measuring 7.0 x 3.0 x 2.5 cm. Lesion closely
approximates overlying skin.
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Fig. 3A. —89-year-old woman with palpable mass in medial aspect of
right breast that had been present for many years. Blue discoloration of skin
is consistent with vascular lesion. At fine-needle aspiration biopsy, mass was
found to be benign. Magnified mediolateral mammogram shows well-circumscribed
macrolobulated nodule.
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Fig. 3B. —89-year-old woman with palpable mass in medial aspect of
right breast that had been present for many years. Blue discoloration of skin
is consistent with vascular lesion. At fine-needle aspiration biopsy, mass was
found to be benign. Power Doppler sonogram obtained in area of palpable mass
shows poorly defined region of mildly increased echogenicity compared with
that of adjacent fat. Single feeding vessel (arrow) is visible at
periphery of mass, but no blood flow is seen within mass.
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Fig. 4A. —83-year-old man with palpable mass in right breast.
Mediolateral oblique mammogram shows well-defined lobulated mass. Retractable
wire was placed to confirm that sonographic findings corresponded to nodule on
mammography.
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Fig. 4B. —83-year-old man with palpable mass in right breast. Sonogram
obtained in area of palpable mass shows poorly defined, mixed echogenic and
isoechoic lesion (arrows). Sixteen-gauge core biopsy was performed
under sonographic guidance. Histologic finding was capillary hemangioma.
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Fig. 5A. —48-year-old woman with palpable mass in lateral aspect of
left breast. As a child, she had received radiation therapy in this area and
in axilla for biopsy-proven capillary hemangioma. Bilateral mediolateral
oblique mammograms show substantial reduction in size of left breast and
increased interstitial markings due to previous radiation therapy. Lobulated
mass containing phleboliths is in left axilla.
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Fig. 5B. —48-year-old woman with palpable mass in lateral aspect of
left breast. As a child, she had received radiation therapy in this area and
in axilla for biopsy-proven capillary hemangioma. Sonogram obtained in area of
palpable mass shows poorly defined, hypoechoic lesion containing
cystic-appearing spaces. No color flow was seen on color Doppler sonography
(not shown).
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Fig. 5C. —48-year-old woman with palpable mass in lateral aspect of
left breast. As a child, she had received radiation therapy in this area and
in axilla for biopsy-proven capillary hemangioma. Two-dimensional axial
gadolinium-enhanced fast spoiled gradient-echo MR image clearly shows extent
of hemangioma (arrow), which extends into axilla.
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Fig. 6A. —63-year-old woman in whom mass was detected in left breast on
screening mammography. Mediolateral oblique mammogram shows irregular mass
with localization wire adjacent to mass.
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Fig. 6B. —63-year-old woman in whom mass was detected in left breast on
screening mammography. Sonogram shows that mass was difficult to visualize
because it was isoechoic compared with adjacent fat. Cursors define mass
measuring 1.3 x 1.1 cm. Histologic finding was hemangioma with adjacent
breast tissue, indicating hemangioma that was intraparenchymal.
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Fig. 7A. —73-year-old man with palpable mass in right breast. Sonogram
shows complex cystic circumscribed mass with thick internal septations. No
color flow was seen on color Doppler sonography (not shown).
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Fig. 7B. —73-year-old man with palpable mass in right breast.
Photomicrograph shows histopathologic specimen obtained at excisional biopsy.
Histologic finding was cavernous hemangioma with markedly dilated vessels
congested with RBCs. Vessel walls were lined by inconspicuous flat endothelial
cells. (H and E, x200)
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Fig. 8A. —63-year-old woman with palpable mass in inferior aspect of
left breast. Mediolateral oblique mammogram of left breast shows irregular,
ill-defined mass.
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Fig. 8B. —63-year-old woman with palpable mass in inferior aspect of
left breast. On sonogram, cursors show well-defined echogenic mass measuring
10 x 6 mm.
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Fig. 8C. —63-year-old woman with palpable mass in inferior aspect of
left breast. Photomicrograph of histopathologic specimen obtained at
sonographically guided 14-gauge core biopsy shows mixture of mature adipose
tissue and proliferation of narrow vascular channels consistent with
angiolipoma. Mature fat cells are separated by branching network of small
vessels that characteristically contain fibrinous thrombi. (H and E,
x100)
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Fig. 9A. —52-year-old man with palpable masses in both breasts that had
been present for many years. Biopsy results for several masses on patient's
trunk showed angiolipomas and lipomas. Bilateral craniocaudal mammograms show
ill-defined low-density nodules in both breasts, corresponding to palpable
masses.
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Fig. 9B. —52-year-old man with palpable masses in both breasts that had
been present for many years. Biopsy results for several masses on patient's
trunk showed angiolipomas and lipomas. Sonogram of palpable mass in medial
aspect of left breast shows well-defined echogenic mass (between
cursors), measuring 2 x 1.2 cm.
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Fig. 10A. —41-year-old woman with fullness and engorgement of right
upper breast. Bilateral mediolateral oblique mammograms show asymmetric
density (arrow) in upper right breast.
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Fig. 10B. —41-year-old woman with fullness and engorgement of right
upper breast. Sonogram of palpable mass shows increased vascularity on color
Doppler evaluation. No discrete mass was detected, although there was diffuse
increased echogenicity in region of palpable abnormality.
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Fig. 10C. —41-year-old woman with fullness and engorgement of right
upper breast. Three-dimensional sagittal gadolinium-enhanced fast spoiled
gradient-echo MR image of right breast shows multiple nodular areas of rapid
and intense contrast enhancement within 7-cm mass. Draining vein
(arrow) is noted. Areas of blood lakes (increased signal intensity on
T1-weighted images, not shown) did not enhance.
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Fig. 10D. —41-year-old woman with fullness and engorgement of right
upper breast. Photomicrograph of histopathologic specimen shows open
anastomosed vascular channels surrounding and invading breast lobule,
consistent with angiosarcoma. Vascular channels were lined by hyperchromatic
focally pleomorphic nuclei. (H and E, x200)
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Copyright © 2005 by the American Roentgen Ray Society.
