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Breast-nonmalignant

Benign tumors / changes

Hamartoma of breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 7 October 2012, last major update April 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Well circumscribed, often encapsulated mass composed of all components of breast tissue

 

Terminology

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● Also called fibroadenolipoma, adenolipoma

 

Epidemiology

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● Rare

● Mean age 45 years

● Rare in teenagers (Breast J 2009;15:515)

 

Etiology

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● May be a malformation, not a neoplasm

 

Clinical features

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Xray: clearly demarcated lesion on mammography

 

Case reports

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● 35 year old woman with coexisting DCIS and infiltrating ductal carcinoma (Breast J 2006;12:368)

● 46 year old woman with myxoid hamartoma and chondroid metaplasia (Malays J Pathol 2009;31:77)

● 53 year old woman with coexisting LCIS and invasive lobular carcinoma (J Clin Path 2002;55:76)

● 57 year old woman with bilateral tumors in axillary accessory mammary glands (APMIS 2006;114:77)

● Case with atypical stromal cells (Pathologica 2007;99:434)

● Cases with coexisting adenofibroma/ALH and infracted fibroadenoma (Arch Pathol Lab Med 2003;127:e151)

● Case designated a choristoma (Hum Pathol 1985;16:739)

● Cases with DCIS (J Clin Path 2002;55:541)

 

Treatment

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● Excision; does not recur if negative margins

 

Gross description (Macroscopy)

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● Well circumscribed mass of firm, rubbery, white tissue, 1-8 cm, more distinctive grossly than microscopically

 

Gross images

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Various images

 

 

                               

Ovoid yellow           Fat, glandular elements                 Smooth and glistening mass

white mass             and stroma in

                                   pregnant patient

 

 

Micro description (Histopathology)

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● Sharply circumscribed mass of disordered breast ducts and lobules

● Ducts often dilated, accompanied by fibrosis

● May have smooth muscle, adipose tissue, hyaline cartilage, pseudoangiomatous hyperplasia

● May resemble gynecomastia due to lack of ducts

Myoid hamartoma: also has smooth muscle stroma; may contain epithelioid cells (Arch Pathol Lab Med 1996;120:676, Hum Pathol 1985;16:212)

 

Micro images

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Dilated ducts and fibrous stroma                                  Breast ducts and adipose tissue (adenolipoma)

 

 

                                                                  

Rounded border and fibrous capsule                           Epithelial and mesenchymal components

 

 

  

Well circumscribed mass with adipose

normal lobules, cystically dilated ducts

 

 

      

Various images

 

 

  

Various images

 

 

                               

With LCIS and invasive                     With high grade DCIS

lobular carcinoma

 

 

                                                               

Well defined fibrous tumor              Adipose tissue plus ducts               With ductal hyperplasia

with ducts separated by                   resembling gynecomastia               resembling gynecomastia

connective tissue

 

 

                               

Smooth muscle bundles                  Hyaline cartilage and

(arrows) and fibrous tissue             adipose tissue

 

 

            

Myoid hamartoma: H&E and smooth muscle actin+

 

Cytology description

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● Moderately cellular, sheets of bland ductal cells and lobular units, bipolar stromal nuclei, varying amounts of adipose tissue, less prominent stromal fragments, occasional apocrine and foamy cells, no atypia

● Findings are not specific (Cancer 2003;99:255, Cytopathology 2003;14:195)


Positive stains

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Negative stains

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Electron microscopy descriptions

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Electron microscopy images

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Molecular / cytogenetics description

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Molecular / cytogenetics images

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Differential Diagnosis

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Gynecomastia-like changes: not sharply circumscribed, merges gradually with normal breast tissue, no lobules present

 

Additional references

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J Clin Path 2002;55:951, Stanford University

 

End of Breast-nonmalignant > Benign tumors / changes > Hamartoma

 

 

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