The patient is a 47-year-old white woman who presented for a routine mammogram. On routine mammogram, an oval, mammographically benign density was seen in the left posterior lower breast in the mediolateral oblique (MLO).
Charles Master, MD
, 4th-year Radiology Resident, and Ruwini de Silva, MD, Attending
GI and Breast Radiologist, St. Vincent's Medical Center of Staten
The patient is a 47-year-old white woman who presented for a
routine mammogram. There was no family history of breast cancer and
no prior breast surgery. She was not receiving any hormone
replacement therapy and had no palpable breast mass. On routine
mammogram, an oval, mammographically benign density was seen in the
left posterior lower breast in the mediolateral oblique (MLO) view
(Figures 1 and 2). Sonographic evaluation of the left breast
revealed a 1.9-cm hyperechoic area with posterior shadowing (Figure
Cavernous breast hemangioma
On the spot compression mammographic views, a focal density,
with sharp anterior margins measuring approximately 2 cm was
identified on the MLO view (Figure 2). It was located very deeply
and its posterior margin could not be adequately visualized
mammographically. The patient subsequently had an ultrasound of the
left breast. Sonographic evaluation of the left breast revealed a
1.9-cm hyperechoic area with posterior shadowing 10 cm from the
nipple at the 6 o'clock axis (Figure 3). Because the lesion was
hyperechoic, the lesion was thought to be benign. Due to the
posterior shadowing of the lesion and its posterior location, which
made adequate follow-up difficult, the patient was advised to have
a core biopsy.
The patient subsequently underwent a core biopsy of the lesion.
The specimens were deep red in color. The lesion was believed to be
a hemorrhagic lesion. Pathology revealed a hemangioma. The patient
had the lesion surgically removed. Pathology revealed a nodule
measuring 1.1 * 0.8 * 0.7 cm and the surrounding tissue was
slightly hemorrhagic (Figure 4). Microscopically, the lesion was
found to be a cavernous hemangioma (Figure 5).
Hemangiomas are benign vascular tumors. They are usually
thin-walled, blood-filled vascular spaces that are separated by
fibrous septa with occasional phleboliths.
Histologically, there are two major types: the capillary hemangioma
and the cavernous hemangioma. Capillary hemangiomas are composed of
blood vessels that resemble capillaries. Cavernous hemangiomas have
large, cavernous vascular channels.
Hemangiomas of the breast can be divided into intralobular and
extralobular types, depending on whether they are found in the
intra- or interlobular stroma.
Hemangiomas within the breast have an incidence of 1.2% to 11%.
Mammographic findings of a breast hemangioma include a normal
mammogram, or a well-circumscribed mass with punctate
Sonographic findings of breast hemangiomas include hypoechoic or
hyperechoic lesions that can be ill-defined or well-defined, and
can have internal bright echoes that likely represent
calcifications within them.
Unlike most cases of breast hemangiomas seen in the literature,
this case did not show any calcifications mammographically, on
ultrasound, or on histology. On ultrasound, it was hyperechoic and
well-defined and also had posterior acoustic shadowing.
There are a few published cases of sonographic findings of
breast hemangiomas. One showed a well-defined, solid, mainly
hypoechoic lesion with small bright echoes consistent with areas of
Another case showed a poorly defined hyperechoic mass with marked
A third case revealed a hyperechoic area with imprecise borders and
a hypoechoic nodule in the center.
A fourth case only described the sonographic findings of
well-defined, hypoechoic, homogenous, and multiple solid lesions
within the breast parenchma.
Pathologically our case was a cavernous hemangioma with no
calcifications seen within it.
The authors would like to thank Dr. Ko of the Department of
Pathology of St. Vincent's Medical Center of Staten Island, NY for
his photographs of the gross pathologic and microscopic findings of