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Presented by Dr. Pedram Argani and prepared by Dr. Jennifer Bynum
This is a 48 year old female with breast fullness.
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1. Question
Week 630: Case 2
This is a 48 year old female with breast fullness.
Correct
Answer: D
Histologic Description: This is a vascular lesion that has large areas which are very bland cytologically. The lesion consists of irregular anastomosing dilated vessels which are situated in fat and do not elicit a stromal reaction. These areas would suggest the diagnosis of hemangioma or angiomatosis. However, one can appreciate the infiltrative nature of the lesion as it permeates normal breast lobules. In addition, the lesion contains more solid areas composed of atypical spindle cells with hyperchromatic nuclei and prominent mitotic activity. These are the typical features of angiosarcoma of the breast parenchyma. The lesion has a prominent low grade periphery which can be mistaken for benign process, but it also has high grade areas in the center.
Differential Diagnosis: Angiomatosis is a bland but infiltrative vascular lesion. While this lesion may infiltrate breast lobules, it should show no evidence of cytologic atypia, and no solid areas. Perilobular hemangiomas involved the lobules, but are well circumscribed, lack atypia, and lack solid areas. Atypical vascular lesions are radiation associated vascular proliferations which occur in the dermis of the skin in patients who have undergone breast conserving therapy with adjuvant radiation therapy. They should not show cytologic atypia or solid areas.
Incorrect
Answer: D
Histologic Description: This is a vascular lesion that has large areas which are very bland cytologically. The lesion consists of irregular anastomosing dilated vessels which are situated in fat and do not elicit a stromal reaction. These areas would suggest the diagnosis of hemangioma or angiomatosis. However, one can appreciate the infiltrative nature of the lesion as it permeates normal breast lobules. In addition, the lesion contains more solid areas composed of atypical spindle cells with hyperchromatic nuclei and prominent mitotic activity. These are the typical features of angiosarcoma of the breast parenchyma. The lesion has a prominent low grade periphery which can be mistaken for benign process, but it also has high grade areas in the center.
Differential Diagnosis: Angiomatosis is a bland but infiltrative vascular lesion. While this lesion may infiltrate breast lobules, it should show no evidence of cytologic atypia, and no solid areas. Perilobular hemangiomas involved the lobules, but are well circumscribed, lack atypia, and lack solid areas. Atypical vascular lesions are radiation associated vascular proliferations which occur in the dermis of the skin in patients who have undergone breast conserving therapy with adjuvant radiation therapy. They should not show cytologic atypia or solid areas.
