Perilobular hemangiomas are the most common type of vascular lesion in the breast and are usually incidental findings. The small round vessels are clustered in a lobulated mass next to a lobule.

Some benign hemangiomas have an infiltrative pattern with many small anastomosing vessels. Unlike angiosarcomas, however, nuclear pleomorphism, cellular tufting, and solid areas are not present.



  • Benign lesions of vascular origin occurring in or near breast parenchyma



  • Possible role for estrogen in development of hemangiomas

    • Hemangiomas are more common in women than in men

    • Hemangiomas at sites other than breast have been reported to

      • Occur after exogenous estrogen treatment

      • Increase in size during pregnancy

    • In a single case, a subcutaneous hemangioma of the breast was diagnosed after initiation of hormone replacement therapy

      • Partial involution was observed after discontinuation of hormone replacement

Hereditary Causes

  • Hemangiomas occur as part of several genetic syndromes

    • Kasabach-Merritt syndrome

      • Most common in extremities but can involve any anatomic site, including breast

      • Breast hemangiomas and angiosarcoma have been reported

    • Poland syndrome

      • Unilateral defect of pectoral muscle and ipsilateral syndactyly

      • Breast may be absent or hypoplastic

      • Rarely, congenital hemangiomas may be present

  • Tumors typically occur in infancy

  • Breast involvement is very rare



  • Incidence

    • Uncommon: ˜ 1% of mastectomies or ˜ 5% of breast biopsies

      • May be found incidentally on microscopy of biopsy material for other indications

  • Age

    • Wide range: 18 months to 82 years

  • Gender

    • Males and females affected


  • Majority are incidental findings in biopsies for other lesions

  • Larger hemangiomas can present as palpable mass

    • Some may be seen as red to purple skin lesion

  • May also be detected as circumscribed masses on screening mammography

Natural History

  • Some lesions may undergo involution or resolve spontaneously


  • Hemangiomas are benign

    • Recurrence after incomplete excision has not been reported

Core Needle Biopsy

  • Majority of vascular lesions diagnosed on core needle biopsy should undergo excision due to concern for undersampling an angiosarcoma

    • Vessels at periphery of an angiosarcoma can appear deceptively benign

  • Majority of image-detected hemangiomas are small circumscribed masses

    • Angiosarcomas are typically larger and have irregular borders

  • Changes caused by needle biopsy should not be mistaken for malignancy in excisional specimen

    • Hemorrhage simulating blood lakes

    • Thrombosis and papillary endothelial hyperplasia simulating anastomosing infiltrative vasculature

    • Infarction and necrosis


Mammographic Findings

  • Oval or lobulated mass

  • Punctate microcalcifications may be present

    • Calcifications likely related to thrombosis and phlebolith formation (coarse or eggshell-like calcifications)

Ultrasonographic Findings

  • Oval mass with circumscribed margins


General Features

  • Hemangiomas are well-circumscribed, soft, spongy masses

  • Rarely palpable

  • Reddish brown color


  • Typically small (0.5-2 cm)

    • Lesions > 2 cm are more likely to be angiosarcomas


Histologic Features

Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hemangiomas

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