Departments of *Pathology †Radiology ‡Surgery, Albert Einstein College of Medicine, Montefiore Medical Center §Eastchester Center for Cancer Care, Bronx, NY.
Am J Surg Pathol. 2016 Oct;40(10):1424-34. doi: 10.1097/PAS.0000000000000668.
Vascular lesions (VLs) of the breast present a diagnostic challenge on breast core biopsy (BCBx). We report on 27 VLs presenting on BCBx. The mean patient age was 60 years, and mean size was 7.5 mm (range, 1.6 to 16 mm). Presentation included palpable mass in 6 (22%), incidental in 6 (22%), and an imaging abnormality in 15 (56%) cases. Imaging impression included hematoma (24%), lymph node (10%), fat necrosis (10%), tortuous vessel (5%), and not provided in 52%. The lesions were classified on the basis of BCBx or BCBx and excision (available in 16 pts) as follows: 1 low-grade angiosarcoma, 8 angiolipomas, 6 capillary hemangiomas, 4 cavernous hemangiomas, 2 hemangiomas (not otherwise specified), 1 papillary endothelial hyperplasia, and 5 perilobular hemangiomas. The angiosarcoma was 9 mm, detected incidentally by magnetic resonance imaging, and showed dissection of stromal collagen, infiltration of glands, high cellularity, moderate cytologic atypia, scant mitotic activity, and Ki-67 reactivity of 10%. Among the 26 benign VLs, worrisome histologic features were noted in 14 on BCBx, including anastomosing vascular channels in 9, moderate cytologic atypia in 4, high cellularity in 2, Ki-67>10% in 2, mitotic activity in 1, and infiltration of glands in 1. Of the 12 VLs without worrisome features, the lesion extended to edge of core in 8, precluding complete evaluation. BCBx of VLs presents diagnostic challenges due to overlapping clinicopathologic and radiologic features with low-grade angiosarcoma. If completeness of removal is documented on BCBx, and cytoarchitectural changes are not worrisome, follow-up could be considered rather than excision. However, only 4 of these cases fulfilled those criteria.
乳腺血管病变（VLs）在乳腺核心活检（BCBx）中具有诊断挑战性。我们报告了 27 例在 BCBx 中出现的 VLs。患者的平均年龄为 60 岁，平均大小为 7.5 毫米（范围为 1.6 至 16 毫米）。表现包括可触及的肿块 6 例（22%），偶然发现 6 例（22%），影像学异常 15 例（56%）。影像学印象包括血肿（24%）、淋巴结（10%）、脂肪坏死（10%）、迂曲血管（5%）和未提供（52%）。这些病变基于 BCBx 或 BCBx 和切除（在 16 例患者中可用）进行分类如下：1 例低度血管肉瘤、8 例血管脂肪瘤、6 例毛细血管血管瘤、4 例海绵状血管瘤、2 例血管瘤（未特指）、1 例乳头状内皮细胞增生和 5 例小叶周围血管瘤。血管肉瘤为 9 毫米，偶然通过磁共振成像发现，表现为基质胶原的剥离、腺体浸润、高细胞性、中度细胞异型性、稀少的有丝分裂活性和 Ki-67 反应性为 10%。在 26 例良性 VLs 中，14 例在 BCBx 中观察到令人担忧的组织学特征，包括 9 例吻合性血管通道、4 例中度细胞异型性、2 例高细胞性、2 例 Ki-67>10%、1 例有丝分裂活性和 1 例腺体浸润。在 12 例无令人担忧特征的 VLs 中，8 例病变延伸至核心边缘，无法进行完整评估。VLs 的 BCBx 由于与低度血管肉瘤具有重叠的临床病理和影像学特征，因此具有诊断挑战性。如果在 BCBx 上记录了切除的完整性，并且细胞结构变化没有令人担忧，则可以考虑随访而不是切除。然而，只有 4 例符合这些标准。
