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Image of the Month—Diagnosis FREE

Arch Surg. 2007;142(2):202. doi:10.1001/archsurg.142.2.202.
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The mass was extirpated by a round block incision, although the nipple-areola complex had a large diameter (7 cm), and a vertical prolongation had to be done to allow the extraction of the giant tumor (13 cm × 14 cm; 740 g). Pathologic examination revealed a breast hamartoma.

Breast hamartomas are uncommon benign lesions. They are well-circumscribed tumors composed of a variable mixture of epithelial elements, fat, and fibrous tissue.1 As it did in our case, a hamartoma may appear as a homogeneously dense, well-circumscribed mass, which can vary in appearance from a classically described mass to an encapsulated, mixed, fatty-fibroglandular mass.2 The role of fine-needle aspiration cytology and core-needle biopsy in making the diagnosis is limited and requires clinical and radiologic correlation to avoid underdiagnosis. In our case, the histologic diagnosis by core-needle biopsy was pseudoangiomatous stromal hyperplasia; this histologic feature needs to be distinguished from another benign and malignant lesion, which sometimes has a similar cytologic apperance.3 The incidence rate of pseudoangiomatous stromal hyperplasia in hamartomas ranges from a high incidence of 71%4 to a low incidence of 16%.5 Hamartomas with associated pseudoangiomatous stromal hyperplasia may show marked vascularity; this was clearly demonstrated in magnetic resonance imaging.4,6 Magnetic resonance imaging of the breast hamartoma revealed a tumor with intermediate signal intensity on both T1- and T2-weighted images, and showed a time-signal intensity curve with a slow and progressive enhancement; dynamic contrast enhancement suggested a benign lesion.7 Usually hamartomas are described as slow-growing lesions; in our case, the mass doubled its size in 10 months. In this situation we had to make a differential diagnosis of a malignant mass; other possible diagnoses included a circumscribed fibrocystic lesion, fibroadenoma, and cystosarcoma phyllodes. The size and weight of the tumor in our case led us to determine it was a giant hamartoma.8 Three months after the removal of the tumor the healthy breast tissue expanded and the breast recovered its usual appearance.

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Submissions

The Editor welcomes contributions to the Image of the Month. Manuscripts should be submitted via our online manuscript submission and review system (http://manuscripts.archsurg.com). Articles and photographs accepted will bear the contributor's name. Manuscript criteria and information are per the Instructions for Authors for Archives of Surgery (http://archsurg.ama-assn.org/misc/ifora.dtl). No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.

Correspondence: Pilar Alonso-Bartolomé, MD, Radiology Division, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla, Santander, Spain 39008 (mpalonso@humv.es).

Accepted for Publication: January 31, 2006.

Author Contributions:Study concept and design: Hernanz, Alonso-Bartolomé, Garijo, Vega, Alvarez, and Gómez-Fleitas. Acquisition of data: Hernanz, Alonso-Bartolomé, and Ortega. Analysis and interpretation of data: Hernanz, Alonso-Bartolomé, and Ortega. Drafting of the manuscript: Hernanz and Alonso-Bartolomé. Critical revision of the manuscript for important intellectual content: Hernanz, Alonso-Bartolomé, Garijo, Vega, Ortega, Alvarez, and Gómez-Fleitas. Administrative, technical, and material support: Hernanz, Alonso-Bartolomé, Garijo, Vega, Ortega, and Alvarez. Study supervision: Gómez-Fleitas.

Financial Disclosure: None reported.

Charpin  CMathoulin  MPAndrac  L  et al.  Reappraisal of breast hamartomas: a morphological study of 41 cases. Pathol Res Pract 1994;190362- 371
PubMed
Georgian-Smith  DKricun  BMcKee  G  et al.  The mammary hamartoma: appreciation of additional imaging characteristics. J Ultrasound Med 2004;231267- 1273
Brogi  E Benign and malignant spindle cell lesions of the breast. Semin Diagn Pathol 2004;2157- 64
PubMed
Fisher  CJHanby  AMRobinson  L  et al.  Mammary hamartoma: review of 35 cases. Histopathology 1992;2099- 106
PubMed
Daya  DTrus  TD’Souza  TJ  et al.  Hamartoma of the breast, an underrecognized breast lesion: a clinicopathologic and radiographic study of 25 cases. Am J Clin Pathol 1995;103685- 689
PubMed
Deshmukh  HPrasad  SPatankar  T A giant vascular hamartoma of the breast in a child. J Postgrad Med 1997;4350- 51
PubMed
Kievit  HCESikkenk  ACThelissen  GRPMerchant  TE Magnetic resonance image appearance of hamartoma of the breast. Magn Reson Imaging 1993;11293- 298
PubMed
Weinzweig  NBotts  JMarcus  E Giant hamartoma of the breast. Plast Reconstr Surg 2001;1071216- 1220
PubMed

Figures

Tables

References

Charpin  CMathoulin  MPAndrac  L  et al.  Reappraisal of breast hamartomas: a morphological study of 41 cases. Pathol Res Pract 1994;190362- 371
PubMed
Georgian-Smith  DKricun  BMcKee  G  et al.  The mammary hamartoma: appreciation of additional imaging characteristics. J Ultrasound Med 2004;231267- 1273
Brogi  E Benign and malignant spindle cell lesions of the breast. Semin Diagn Pathol 2004;2157- 64
PubMed
Fisher  CJHanby  AMRobinson  L  et al.  Mammary hamartoma: review of 35 cases. Histopathology 1992;2099- 106
PubMed
Daya  DTrus  TD’Souza  TJ  et al.  Hamartoma of the breast, an underrecognized breast lesion: a clinicopathologic and radiographic study of 25 cases. Am J Clin Pathol 1995;103685- 689
PubMed
Deshmukh  HPrasad  SPatankar  T A giant vascular hamartoma of the breast in a child. J Postgrad Med 1997;4350- 51
PubMed
Kievit  HCESikkenk  ACThelissen  GRPMerchant  TE Magnetic resonance image appearance of hamartoma of the breast. Magn Reson Imaging 1993;11293- 298
PubMed
Weinzweig  NBotts  JMarcus  E Giant hamartoma of the breast. Plast Reconstr Surg 2001;1071216- 1220
PubMed

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