Clinical History
A 47-year-old female underwent screening mammography. She had no prior history of any breast pain, lump, trauma, bleeding and/or discharge. There was no family history of breast cancer.
Imaging Findings
Screening mammography (mediolateral oblique and craniocaudal views) revealed focal asymmetry with specks of punctate calcification in upper outer quadrant of left breast (Fig. 1 a, b, c).
Targeted ultrasonography of the left breast revealed a cluster of tubular low echogenic area intermingled with normal parenchyma in the retroglandular region in the upper outer quadrant of the left breast. On color flow mapping, there was increased vascularity in the tubular low echogenic area suggesting vascular lesion (Fig. 2 a, b).
On MRI, the lesion demonstrated intermediate signal on T1 weighted (Fig. 3) and intermediate to high signal on T2 weighted images (Fig. 4). There was avid early homogenous enhancement following contrast administration with persistent uptake of contrast (Fig. 5).
Under aseptic precautions stereotactic core biopsy of the lesion was performed.
Histopathology revealed angiomatosis of breast with focus of osseous metaplasia (Fig. 6 a, b, c].
Discussion
Angiomatosis is a benign vascular lesion that has been described rarely in the breast. Only few cases of angiomatosis have been reported till now. To the best of our knowledge, no case of angiomatosis with osseous metaplasia has been reported till now. The diagnosis of angiomatosis is challenging for radiologists as well as pathologists.
Angiomatosis is a benign lesion which grows diffusely in the breast and surrounds the ducts and lobules. It is composed of large irregular vascular spaces lined by flat endothelial cells and lacks a muscular wall. There is no atypia or invasion of adjacent ducts or lobules (1, 2).
These lesions can be congenital or acquired. They are usually seen in young women who are asymptomatic or present with anisomastia.
On mammogram, they are usually obscure. Occasionally lobulated density or focal asymmetry may be seen. Ultrasonography may show tubular, cystic channels with or without septae. Colour Doppler studies may show uptake of colour by these lesions. On MRI, these appear as cystic lesions which are isointense on T1-weighted images and hyperintense on T2-weighted images. On contrast-enhanced MRI, these show avid and persistent enhancement. Early feeding artery and draining vein may be seen.
Diagnosis of vascular malformation should be considered in any breast lesion showing tubular channels filled with colour on Doppler study and showing hyperintense signal on T2 weighted MRI images.
Differential Diagnosis List
Angiomatosis of breast with osseous metaplasia
Perilobular haemangioma
Pseudoangiomatous stromal hyperplasia
Angiosarcoma
Cystic lymphangioma
Final Diagnosis
Angiomatosis of breast with osseous metaplasia
