Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India
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|Date of Submission||29-Dec-2020|
|Date of Acceptance||12-Dec-2022|
|Date of Web Publication||07-Feb-2023|
Hamartoma of the breast is a rare benign lesion that leads to unilateral breast enlargement with evidence of a localized palpable mass. Ultrasonography findings are typical and include a well-defined mass lesion of heterogeneous echotexture consisting of mixed echogenic and sonolucent areas. This case report describes a hamartoma of the breast in a 17-year-old female.
Keywords: Breast, hamartoma, ultrasonography
| Introduction|| |
Hamartomas of the breast are also known as fibroadenolipomas due to their composition of variable amounts of glandular, fatty, and fibrous tissue. More often, the diagnosis of hamartoma is incidental in females older than 40 years on mammography screening. Sonological appearances of the entity are similar to fibroadenoma, with no evidence of calcifications. Very rarely, the lesion may undergo malignant transformation to lobular or invasive ductal carcinoma.
| Case Report|| |
A 17-year-old young female patient presented to the surgery department with complaints of the lump in the breast that progressively increases in size for 2 months. Clinical examination revealed a well-defined, nontender retro-areolar mass. Subsequently, the patient was referred for ultrasonography and fine-needle aspiration cytology (FNAC). High-resolution ultrasonography of the right breast revealed a well-defined, encapsulated mass lesion measuring 4 cm × 6 cm with smooth margins and heterogeneous echotexture in the retro-areolar location [Figure 1]a and [Figure 1]b. There was no evidence of calcifications, focal duct dilatation, or significant internal vascularity within the lesion. There was no significant ipsilateral axillary lymphadenopathy. On ultrasonography, a diagnosis of breast hamartoma was made. FNAC revealed findings of fat and connective tissue interspersed with areas of the glandular tissue of the breast parenchyma [Figure 2]. The patient was referred to the department of general surgery for excision. Histopathological findings revealed glandular breast parenchyma with scattered cystic areas and myxoid components consistent with features of breast hamartoma.
|Figure 1: (a) Longitudinal ultrasonography image on a curvilinear probe demonstrating a well-defined encapsulated retro-areolar lesion of the breast having heterogeneous echotexture, (b) High resolution ultrasonography image demonstrating a smooth-edged solid mass lesion in the retro-areolar location having heterogeneous echotexture with absence of calcifications or duct dilatation|
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|Figure 2: Histopathology image demonstrating glandular tissue of the breast with disordered ducts and lobules admixed with smooth muscle fibers and adipose tissue consistent with features of breast hamartoma (H and E, ×200)|
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The case report was approved by the Institutional Ethics Committee (IEC, St. John's Hospital; IEC Approval Reference Number: SJH/72/2020; IEC Approval Date: December 1, 2020). The patient gave informed written consent to publish his case and clinical images.
| Discussion|| |
Hamartomas of the breast are well-defined, nontender, soft-tissue mass lesions of the breast parenchyma that represent 4%–8% of benign lesions of the breast commonly noted as incidental findings in women above 40 years of age. On high-resolution ultrasonography, breast hamartomas are encapsulated and demonstrate heterogeneous echotexture as opposed to fibroadenomas which are well-defined, encapsulated, and hypoechoic. However, ultrasonography appearances of breast hamartoma can be widely variable, ranging from a well-defined solid hypoechoic mass lesion interspersed with hyperechoic bands to an isoechoic lesion with multiple cystic areas. There may be absent posterior acoustic shadowing to partial or complete acoustic shadowing by the mass lesion. Differential diagnosis of well-defined solid soft tissue mass lesions of the breast includes fibroadenoma, lipoma, galactocele, and fat necrosis. Due to the variable appearance of breast hamartomas on ultrasonography, diagnosis is largely relied on findings of histopathological examination.
| Conclusion|| |
This case report describes the sonological appearance of a breast hamartoma in a young female patient, which is a rare presentation. Breast hamartomas may infrequently show complications such as hemorrhage within the lesion and malignant transformation to lobular carcinoma. Radiologists and sonologists must be aware of this sonological appearance to help diagnose a breast hamartoma which is an incidentally detected mass lesion of the breast parenchyma containing a thin capsule or pseudocapsule with heterogeneous echogenicity on high-resolution ultrasonography.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Pui MH, Movson IJ. Fatty tissue breast lesions. Clin Imaging 2003;27:150-5.
Murat A, Ozdemir H, Yildirim H, Poyraz AK, Ozercan R. Hamartoma of the breast. Australas Radiol 2007;51:B37-9.
Park SY, Oh KK, Kim EK, Son EJ, Chung WH. Sonographic findings of breast hamartoma: Emphasis on compressibility. Yonsei Med J 2003;44:847-54.
Department of Radiology, Holy Family Hospital, Thodupuzha - 685 605, Kerala
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]