Vascular proliferations of the breast

Abstract

Vascular proliferations of the breast are uncommon but potentially diagnostically challenging lesions. Clinically apparent processes are more likely to be malignant; however, a range of benign entities which must be differentiated from angiosarcoma also exists. This review discusses first, breast lesions of apparent vascular origin, then benign and histologically bland perilobular, cavernous and capillary haemangiomas. Subsequently, more diagnostically challenging, atypical haemangiomas, papillary endothelial hyperplasia, angiomatosis and angiolymphoid hyperplasia with eosinophilia (epithelioid haemangioma) are considered. In addition, lesions with low‐grade malignant potential such as haemangiopericytomas and epithelioid haemangioendotheliomas may rarely present in the breast. However, primary angiosarcomas and radiation‐associated vascular lesions are reviewed in depth, as these entities are of greatest clinical and pathological significance.

Changing clinical presentation of angiosarcomas after breast cancer: from late tumors in edematous arms to earlier tumors on the thoracic wall

“…Green symbols represent cases linked to edematous arms (Stewart-Treves syndrome), whereas red symbols define angiosarcomas that have developed within irradiated fields on the thoracic wall. The increasingly steeper slopes reflect the shorter time to angiosarcoma in more recent cases controversial and many angiosarcomas also contain areas with atypical vascular cellularity [12,13,20]. Discoloration of the skin followed by hematoma-like lesions and sometimes subsequent appearance of multiple bluish-reddish nodules was in our series reported by 13 women, whereas the remaining 18 females presented with subcutaneous lumps without cutaneous precursors (although they sometimes were ulcerated once the patient sought medical attention).…”

“…Following the initial observations, multiple reports have described angiosarcomas associated with long-standing and pronounced edema [6][7][8][9][10]. In 1987, Body et al reported secondary cutaneous angiosarcomas within irradiated fields, and this study has been followed by a number of reports on radiation-induced angiosarcomas [9,[11][12][13]. Secondary sarcomas are rare long-term complications to radiotherapy, and angiosarcomas have been reported to account for about one-third of these tumors [6,7,14].…”

Atypical vascular lesion of the breast

“…3 Typical late radiationinduced changes seen within the skin include hyalinization of dermal collagen fibers, swelling of endothelial cells, telangiectatic dilation of dermal vessels, and proliferation and hyalinization of deeper vessels. 4,5 Because such skin changes usually stop within 3 years of radiation therapy, observed changes after this period should alert the clinician. 5,6 We report the case of a patient who developed an AVL and suggest that more guidelines would be beneficial to help clinicians treat these patients.…”

Atypical Cavernous Hemangioma of the Breast Associated with Multiple Soft Tissue Phleboliths

“…Vascular tumors are rarely seen in the breast (1)(2)(3). The most common vascular tumors are hemangiomas and angiosarcomas (2).…”

“…A search of the surgical pathology records of approximately 10,000 breast biopsies evaluated by Glazebrook et al (4) yielded 18 cases of benign vascular tumors (15 hemangiomas and three angiolipomas) and two malignant angiosarcomas. The majority of clinically symptomatic intraparenchymal vascular tumors are angiosarcomas (1). Hemangiomas of the breast are well-defined benign tumors which are usually located superficially (4).…”