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Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Kevan Salimian
A 30 year-old female with a breast mass
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Question 1 of 1
1. Question
A 30 year-old female with a breast mass
Choose the correct diagnosis:
Correct
Diagnosis: A. Angiolipoma
Histology:
The soft tissue mass consists primarily of mature adipocytes with scattered capillaries; the capillaries are arranged in variable density, with some areas of low vascularity and some areas where the capillaries are clustered together in close proximity. The capillaries are lined by a single layer of bland endothelial cells and may show associated supportive stromal cells (smooth muscle cells and fibroblasts). Scattered capillaries show fibrin thrombi within their lumens.Discussion:
The histologic features of mature adipose tissue with an associated bland vascular component containing fibrin thrombi are characteristic of a benign angiolipoma, which commonly present as painful subcutaneous masses. Angiolipomas can occur throughout the body and are occasionally encountered on core needle biopsy of the breast, both in male and female patients. In contrast to other body sites, the angiolipomas of the breast are not as commonly painful. The differential diagnosis of angiolipoma of the breast includes other fatty tumors such as lipoma or even a benign breast fat lobule, as well as vascular neoplasms such as hemangioma or angiosarcoma. The diagnosis can be particularly challenging on core needle biopsy of a breast mass with a clinical concern of low grade angiosarcoma, because the well circumscribed and encapsulated nature of a cellular angiolipoma may not be appreciated on the limited tissue sampling of a core biopsy. The presence of fibrin thrombi greatly favors an angiolipoma, whereas the presence of nuclear atypia, mitotic activity, and an infiltrative pattern favors a low grade angiosarcoma. Clinicoradiographic correlation of tumor size, location, and clinical history can be helpful. However, the distinction may not always be possible, and in some cases, an excisional biopsy is necessary for definitive classification. Many observers recommend conservative excision of any vascular lesion diagnosed on breast core needle biopsy to exclude the potential of lesional heterogeneity in an angiosarcoma. Clinicoradiographic correlation of any finding on breast core needle biopsy is always recommended.References:
1. Kryvenko ON, Chitale DA, VanEgmond EM, Gupta NS, Schultz D, Lee MW. Angiolipoma of the female breast: clinicomorphological correlation of 52 cases. International journal of surgical pathology. 2011;19(1):35-43.Incorrect
Diagnosis: A. Angiolipoma
Histology:
The soft tissue mass consists primarily of mature adipocytes with scattered capillaries; the capillaries are arranged in variable density, with some areas of low vascularity and some areas where the capillaries are clustered together in close proximity. The capillaries are lined by a single layer of bland endothelial cells and may show associated supportive stromal cells (smooth muscle cells and fibroblasts). Scattered capillaries show fibrin thrombi within their lumens.Discussion:
The histologic features of mature adipose tissue with an associated bland vascular component containing fibrin thrombi are characteristic of a benign angiolipoma, which commonly present as painful subcutaneous masses. Angiolipomas can occur throughout the body and are occasionally encountered on core needle biopsy of the breast, both in male and female patients. In contrast to other body sites, the angiolipomas of the breast are not as commonly painful. The differential diagnosis of angiolipoma of the breast includes other fatty tumors such as lipoma or even a benign breast fat lobule, as well as vascular neoplasms such as hemangioma or angiosarcoma. The diagnosis can be particularly challenging on core needle biopsy of a breast mass with a clinical concern of low grade angiosarcoma, because the well circumscribed and encapsulated nature of a cellular angiolipoma may not be appreciated on the limited tissue sampling of a core biopsy. The presence of fibrin thrombi greatly favors an angiolipoma, whereas the presence of nuclear atypia, mitotic activity, and an infiltrative pattern favors a low grade angiosarcoma. Clinicoradiographic correlation of tumor size, location, and clinical history can be helpful. However, the distinction may not always be possible, and in some cases, an excisional biopsy is necessary for definitive classification. Many observers recommend conservative excision of any vascular lesion diagnosed on breast core needle biopsy to exclude the potential of lesional heterogeneity in an angiosarcoma. Clinicoradiographic correlation of any finding on breast core needle biopsy is always recommended.References:
1. Kryvenko ON, Chitale DA, VanEgmond EM, Gupta NS, Schultz D, Lee MW. Angiolipoma of the female breast: clinicomorphological correlation of 52 cases. International journal of surgical pathology. 2011;19(1):35-43.
