Breast cancer associated with mammary hamartoma

Concurrent invasive ductal carcinoma and ductal carcinoma in situ arising inside and outside a breast hamartoma: A case report

BACKGROUND

Breast hamartomas are rare benign breast tumors, with an incidence rate of 0.8%-4.8%. Further, the coexistence of hamartomas and carcinoma is also uncommon. Our case report presents a unique instance where invasive ductal carcinoma (IDC) and ductal carcinoma in situ were found both inside and outside a breast hamartoma. This is the second case reported in the literature.

CASE SUMMARY

A 51-year-old woman presented with a 6.0 cm breast tumor on mammography and ultrasound, with suspicious areas indicative of malignant transformation. Biopsy of the suspicious area confirmed IDC with intraductal carcinoma. Breast magnetic resonance imaging showed typical hamartoma changes with irregular areas of abnormal enhancement both inside and outside. A breast-conserving surgery was performed, and postoperative pathology confirmed mammary hamartoma, concurrent with IDC and intraductal carcinoma occurring both inside and outside the hamartoma. Subsequently, appropriate adjuvant therapy was initiated. Currently, the patient is in good condition. Breast cancer may be located both inside and outside the ipsilateral mammary hamartoma, which is difficult to detect preoperatively, especially when there is a focus of intraductal carcinoma, requiring accurate assessment of the tumor extent by modern imaging techniques. Early detection of the coexistence of cancer is clinically important as it can alter patient management.

CONCLUSION

This case emphasizes the importance of modern imaging techniques in accurately evaluating mammary hamartomas associated with malignancies prior to surgery.

Breast hamartomas associated with epithelial atypia and malignancy: are there specific clinical, radiological or pathological features that identify at risk patients?

PURPOSE

Breast hamartomas are rarely associated with epithelial atypia or malignancy. Since the introduction of digital mammography in the UK from 2008, hamartoma detection has increased. The aim of this study was to identify if there are characteristic clinical, radiological or histological features that distinguish hamartomas with intralesional atypia/malignancy (complex hamartomas, CH) or ipsilateral/contralateral atypia/malignancy (non-CH) from those without atypia/malignancy at diagnosis (other benign hamartomas, BH).

METHODS

We performed a retrospective single-institution review of 450 hamartomas reported between 2010 and 2023. Anonymised H&E sections and imaging of CH and non-CH were reviewed to identify distinguishing features.

RESULTS

13,441 benign breast lesions were biopsied/resected between 2010 and 2023 including 450 hamartomas (3.3%), 19 of which (4.2%) were associated with atypia or malignancy. 14 were analysed further (7 CH; 7 non-CH). The mean age of CH plus non-CH patients was significantly higher than patients with BH (47.5 vs. 40.6 years; p = 0.03). The mean size of CH was greater than non-CH (32.1 mm vs.17.6 mm; p = 0.06). There was a statistically significantly higher incidence of atypical/malignant lobular lesions (ALH/LCIS/ILC) in CH vs. non-CH (42.9% vs 0%; p = 0.05). MRI was performed in 2 CH and 3 non-CH; in all 5 the associated malignancy was detected. There was no significant difference between the CH and non-CH group in ultrasound/mammographic features, other hamartoma histological features or other associated benign breast changes.

CONCLUSIONS

Ultrasound/mammogram are not sufficiently sensitive to identify hamartomas with associated atypia/malignancy. Certain hamartoma features may preferentially be associated with atypia/malignancy and which merit further radiological and/or detailed histological investigation.

Breast Hamartoma With Synchronous Contralateral Breast Cancer: A Case Report

Breast hamartoma is a rare benign growth often overlooked and consequently not well-documented, mainly due to insufficient recognition of its distinct clinical and histological features. Increasing awareness about this relatively obscure benign condition is crucial because it can mimic both benign and malignant breast tumors clinically. Its association with breast cancer is infrequently documented in medical literature. Additionally, it may be linked to PTEN hamartoma tumor syndrome, which involves a mutation of the PTEN tumor suppressor gene. This article presents a case study of a young woman diagnosed with left breast carcinoma, where imaging revealed a sizable mass on the opposite breast consistent with a breast hamartoma.

Ductal carcinoma in situ of the breast arising in encapsulated mammary hamartoma ; A case report

Mammary hamartoma is benign lesion and relatively rare. 17 cases of breast cancer associated with a hamartoma had been previously documented in the literature. We describe herein a case of noninvasive ductal carcinoma of the breast arising in hamartoma in a woman of 60's. The discordance of images of the mass between mammogram and ultrasonogram can lead us to detect the carcinoma within the hamartoma in our case. J. Med. Invest. 67 : 368-371, August, 2020.

Hamartoma of the breast in a man: A rare case report

RATIONALE

Mammary hamartoma is a rare benign breast tumor, composed of ducts, lobules, fibers, and adipose tissue. We describe a mammary hamartoma in a man; this is the fourth case being reported in the literature.

PATIENT CONCERNS

A 30-year-old man presented with a 1-month history of a painless mass in his right breast.

DIAGNOSIS

Ultrasound imaging and mammography revealed a lesion, approximately 2.0 cm × 2.0 cm in size, in the right breast, which was considered to be either a lipomyoma or an adenoma fibrosum.

INTERVENTIONS

The mass was surgically resected. Pathological examination confirmed the diagnosis of mammary hamartoma.

OUTCOMES

The patient was discharged from the hospital after surgery. There was no sign of reoccurrence during a 1-year follow-up period.

LESSONS

At present, mammary hamartoma is considered to be a benign lesion, usually treated by surgical resection. Some reports have suggested a possible association between a hamartoma and the development of breast malignancy. The pathology and biology of an association between a mammary hamartoma and malignancy have not been defined to date.

What you see is not always what you get: Radiographic-pathologic discordance among benign breast masses

The differential diagnosis for benign breast masses is broad and ranges from common lesions like fibroadenomas to rare masses like breast hamartomas. Fibroadenomas are proliferative benign masses made up of fibroglandular tissue. Hamartomas are neoplasms comprised of different tissues that are endogenous to the area where they originate. Breast hamartomas specifically, are rare, benign slow growing tumours comprised of fibrotic stroma, adipose, glandular tissue, and epithelial components. Both lesions are painless, firm, and are typically palpable on clinical exam. Given their similarities in composition, diagnosing these masses can be challenging, but may be confirmed with ultrasonography, mammogram, computed tomography, magnetic resonance imaging, or via histological specimen. Once diagnosed, surgical excision is the preferred treatment option. We present a 33-year-old woman with a large left breast mass that gradually increased in size and provide a review of the current literature regarding the challenge of distinguishing between breast fibroadenomas and hamartomas.

Invasive ductal carcinoma detected within a fibroadenolipoma through digital breast tomosynthesis

A 52-year-old patient referred to our hospital for a screening mammogram showed a suspicious new architectural distortion. Previously, a fibroadenolipoma within the right breast was diagnosed clinically and radiologically. Further work-up with tomosynthesis, magnetic resonance imaging, and magnetic resonance-guided biopsy showed an invasive ductal carcinoma within the fibroadenolipoma, which are usually benign breast lesions not associated with malignancy. This case report offers a review of the literature and a discussion of signs, which should alert the radiologist.

The First Case of HER2+ Invasive Ductal Carcinoma Arising From a Breast Hamartoma and Literature Review

Carcinomas arising from breast hamartomas are exceedingly rare. We present the first reported case of an African-American female presenting with a right breast lump and a subsequent mammogram suggestive of a hamartoma. She later underwent lumpectomy and was found to have HER2+ invasive ductal carcinoma (IDC) arising from a hamartoma. She was amenable to HER2-targeted trastuzumab, hormone therapy and adjuvant radiation but declined chemotherapy. In a review of the literature, IDC is the predominant neoplastic type found in hamartomas. The average hamartoma size at time of neoplasm diagnosis is 6.0 cm. Patients with hamartomas greater than 6.0 cm, with changes in calcification pattern; new nodules or asymmetry should be considered for additional evaluation with ultrasound, MRI and/or biopsy. HER2 status is under-reported among cases and should be evaluated in any malignancy found within hamartomas as HER-2 therapy has improved overall survival and recurrence free survival in HER2+breast cancer patients.

[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]

OBJECTIVES

To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma.

METHODS

Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases.

RESULTS

For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).

Giant breast hamartoma in a 41-year-old female: A case report and literature review

Breast hamartoma is an uncommonly reported benign breast lesion of uncertain cause and pathogenesis. The diagnosis of breast hamartoma by a single method such as mammography, magnetic resonance imaging or sonography is inadequate. In the majority of cases, the breast hamartoma is excised a few years after it has occurred when it is not too big. In the present report, however, a particularly large lesion with a long history is described. Such a case has rarely been reported and shows the necessity of early surgery to reduce trauma as much as possible. Excision of hamartoma was successfully performed and an 11×9×3.5-cm tumor was completely excised. The present study also reviews the literature on breast hamartoma.

Myoid hamartoma of the breast with focal chondromyoxid metaplasia and pseudoangiomatous stromal hyperplasia: A case report

Hamartomas of the breast, also known as fibroadenolipomas, lipofibroadenomas or adenolipomas, are benign lesions. Hamartomas account for between 0.04 and 1.15% of all benign breast tumors in females. Myoid hamartoma of the breast (MHB) is extremely rare. The present study describes a case of MHB in a 44-year-old female. Screening mammography revealed a lobulated partial indistinct isodense mass measuring ~3.8 cm in the upper outer quadrant of the left breast. Sonographic examinations revealed a 2–3-cm mass in the left breast, which was fairly well circumbscribed and demonstrated complex scattered echogenic areas and isoechoic tissue. A core needle biopsy demonstrated fibrocystic changes, with small focal ductule aggregations. As malignancy could not be excluded, a partial mastectomy was performed using a circumareolar incision. The mass was histopathologically diagnosed as MHB with focal chondromyoxid metaplasia and pseudoangiomatous stromal hyperplasia. The histological diagnosis was based upon the findings of the well-circumscribed tumor, which was composed of entrapped mammary ducts, fat cells and myoid stromal components, with focal chondromyxoid metaplasia and pseudoangiomatous stromal hyperplasia. The tumor cells exhibited diffuse cluster of differentiation 34-positive immunoreactivity, which was consistent with a diagnosis of pseudoangiomatous stromal hyperplasia.

Breast hamartoma: a clinicopathologic analysis of 27 cases and a literature review

OBJECTIVES

Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. The pathogenesis is still poorly understood and breast hamartoma is not a well-known disorder, so its diagnosis is underestimated by clinicians and pathologists. This study was designed to present our experience with breast hamartoma, along with a literature review.

METHOD

We reviewed the demographic data, pathologic analyses and imaging and results of patients diagnosed with breast hamartoma between December 2003 and September 2013.

RESULTS

In total, 27 cases of breast hamartoma operated in the Ankara University Medicine Faculty's Department of General Surgery were included in the study. All patients were female and the mean age was 41.8±10.8 years. The mean tumor size was 3.9±2.7 cm. Breast ultrasound was performed on all patients before surgery. The most common additional lesion was epithelial hyperplasia (22.2%). Furthermore, lobular carcinoma in situ was identified in one case and invasive ductal carcinoma was observed in another case. Immunohistochemical staining revealed myoid hamartoma in one case (3.7%).

CONCLUSION

Breast hamartomas are rare benign lesions that may be underdiagnosed because of the categorization of hamartomas as fibroadenomas by pathologists. Pathologic examinations can show variability from one case to another. Thus, the true incidence may be higher than the literature indicates.

Invasive ductal carcinoma in a mammary hamartoma: case report and review of the literature

Mammary hamartomas are typically a benign condition and rarely develop into malignant lesions. Only 14 cases of carcinomas associated with a hamartoma have been documented in the literature. In this case report, we describe a case of invasive ductal carcinoma within a hamartoma in a 72-year-old woman. Mammography, ultrasonography, and magnetic resonance imaging showed the features of a typical hamartoma with a suspicious mass arising in it. This case illustrates the importance of identification of unusual findings in a typical mammary hamartoma on radiologic examinations.