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Breast Hamartoma

Breast Fibroadenolipoma

A hamartoma is a benign tumor composed of various tissues, and one of its locations may be the breast. Patients can present with a painless, asymptomatic and well-demarcated palpable mass in a breast hamartoma. Imaging studies such as mammography, ultrasonography, and magnetic resonance imaging (MRI) show specific radiologic features, whereas a biopsy, either fine needle aspiration or core needle, may be sometimes necessary to confirm the diagnosis.


Presentation

Defined as a well-established mass with a still incomplete etiology, hamartoma is a rare benign tumor that contains a mixture of different tissues (fibrous, adipose, glandular, and potentially other) in various proportions [1] [2] [3]. Numerous sites in the body may be the location of its development, including the breast, and between 4-8% of all benign breast lesions, are attributed to hamartomas [3]. This benign tumor has been reported across different age groups after puberty [3] [4], but the majority of patients are women in their 30s and 40s [1] [2] [4] [5]. The clinical presentation is characterized by the presence of a sharply defined, painless, and asymptomatic oval or round-shaped mass in the breast area that is freely palpable [2] [3] [4] [6]. The nodular appearance of the mass is accompanied by its smooth surface and a soft consistency [3]. However, studies show that up to 60% of breast hamartomas are not possible to palpate, and are thus interpreted as subclinical tumors [3]. Hamartomas are most commonly found in the outer quadrants, and it is not uncommon for the diagnosis to be made incidentally during evaluation of other breast-related pathologies [2] [4]. Additional symptoms are not present in the setting of hamartomas, which is one of the main clinical features of this tumor [3]. Furthermore, breast hamartomas are mobile and not attached to the surrounding muscle or skin tissue, which might be an important clinical sign as well [6] [7].

Distractibility
  • I have been seen by a different Consultant for each appt (which has driven me to distraction as they all have differing views!!!)[forum.breastcancercare.org.uk]
Breast Mass
  • CONCLUSION: PDVF imaging during breast sonography is an invaluable technique in the identification of breast hamartomas from other benign or malign breast masses.[ncbi.nlm.nih.gov]
  • It can present as a breast mass and therefore additional care needs to be taken to rule it out in the differential diagnosis of breast carcinoma. We report a case of a breast hamartoma treated at the European Institute of Oncology.[ncbi.nlm.nih.gov]
  • Excised right and left breast masses were 25 19 cm and 21 18 cm in diameter, respectively. Cut sections of both breast masses showed similar features with multinodular appearance and focal fibromyxoid areas.[jbd.or.kr]
  • Abstract The mammographic appearance of breast hamartoma, a benign cause of a breast mass, is characteristic. We present four cases from the University of Virginia to review the mammographic, pathologic, and clinical features of this unusual entity.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses.[ncbi.nlm.nih.gov]
Forgetful
  • Don't give in to them and just forget it. Push them until you get an answer. Good luck. I hope you get your answer soon. 1 Like about 5 years ago StamPurr I have always had lumpy, bumpy, dense breast tissue.[whatnext.com]
  • Back to Types of Benign Lesions list OR our up-dated Survival, Incidence and Mortality Rates OR breast cancer Treatments … and don’t forget our brand new Homepage .[breast-cancer.ca]
  • You are your own best advocate, don't forget that. Hugs to you in this scary time. When life knocks you down, roll over, and look at the stars.[community.breastcancer.org]

Workup

A detailed physical examination, together with a properly obtained patient history, is the first and perhaps most important step in order to make the diagnosis of a breast hamartoma. Adequate palpation of both breasts and the respective quadrants can result in detection of a mass, after which the use of various imaging studies might be employed. Various procedures have been mentioned, one of the more useful being mammography, the gold-standard procedure in the assessment of breast tissue [5] [8]. A nonhomogeneous mass composed of adipose, fibrous and glandular tissue that is often enclosed by a thin capsule is the hallmark of a breast hamartoma on mammography, but the variability in the percentage of fat and glandular/connective tissue might pose a challenge to the physician [1] [2] [8]. For this reason, ultrasonography (US), but also MRI, might be used as adjunctive or even superior methods compared to mammography [1] [5]. Main findings on the US are the absence of a retrotumor acoustic phenomenon, which is frequently found in malignant lesions [2] [8]. On MRI, breast hamartomas are visualized as heterogeneous lesions with a sharp and clearly delineated capsule described as a hypointense rim [1]. As mentioned previously, the distribution and dominance of different tissues may necessitate for a biopsy sample to be obtained, either by a core needle biopsy or a fine needle aspiration (FNAC), both valuable in the workup of this tumor [1] [2] [6].

Treatment

  • […] and Treatment "John Paul II", Campobasso, Italy. 3 Department of Radiotherapy, Catholic University of the Sacred Heart-Foundation for Research and Treatment "John Paul II", Campobasso, Italy.[ncbi.nlm.nih.gov]
  • TREATMENT: She underwent unilateral reduction mammaplasty. Intraoperative findings were that of a giant hamartoma. The tumour was removed and the breast reconstructed using an inferior pedicled reduction mammaplasty.[ncbi.nlm.nih.gov]
  • Radiology, Catholic University of the Sacred Heart-Foundation for Research and Treatment “John Paul II”, L.go Agostino Gemelli, n 1, 86100, Campobasso, Italy.[content.iospress.com]
  • Generously illustrated with over 700 photographs, drawings, histopathology slides, radiographs, and mammographs, this color atlas provides a step-by-step guide to the differential diagnosis and treatment of the most prevalent diseases of the breast.[books.google.com]
  • In this study, we report a case of giant hamartoma of the breast in a young postlactational female patient, including treatment of the tumor by excisional biopsy and correction of the resultant breast deformity by mastopexy.[journals.lww.com]

Prognosis

  • They are treated, if at all, by surgical resection, with an excellent prognosis: generally, the only real danger is the inherent possibility of surgical complications.[en.wikipedia.org]
  • Prognosis.- H. Malignant Lymphomas.- I. Incidence.- II. Clinical Features.- III. Pathology.- IV. Treatment.- V. Prognosis.- VI. Summary.- J. Bone Sarcomas.- K. Summary.- References.- Male Breast Cancer.- A. Introduction.- B. Etiology.- I.[amazon.de]
  • Surgical excision is the treatment of choice, and the prognosis is generally good as recurrence rate is very less.[jiaomr.in]
  • Liposarcomas: Prognosis and management. J Surg Oncol 1980;14:245-9. [ PUBMED ] [Figure 1] , [Figure 2] , [Figure 3] , [Figure 4][cancerjournal.net]

Etiology

  • Defined as a well-established mass with a still incomplete etiology, hamartoma is a rare benign tumor that contains a mixture of different tissues (fibrous, adipose, glandular, and potentially other) in various proportions.[symptoma.com]
  • ) Arrigoni et al. first used the term hamartoma in 1971 ( Surg Gynecol Obstet 1971;133:577 ) Also called fibroadenolipoma, adenolipoma Epidemiology Uncommon, 5% of all benign breast masses Mean age 45 years Rare in teenagers ( Breast J 2009;15:515 ) Etiology[pathologyoutlines.com]
  • The etiology of melorheostosis is unknown. Osteopathia striata has an autosomal dominant pattern of inheritance when associated with sclerosis of the skull base. [16] Cartilage-forming tumors The etiology of osteochondroma is unknown.[emedicine.medscape.com]
  • The exact etiology of lipomas and their variants is not well established.[egms.de]
  • Breast: 8 cases of hamartoma per 20,000 mammograms Kidney: renal hamartoma (angiomyolipoma) found in 40–80% of patients with tuberous sclerosis Etiology and Pathophysiology Functional disorder will depend on tissue of origin.[unboundmedicine.com]

Epidemiology

  • The principal aim of Oncology Letters is to provide the prompt publication of original studies of high quality that pertain to clinical oncology, chemotherapy, oncogenes, carcinogenesis, metastasis, epidemiology and viral oncology in the form of original[ingentaconnect.com]
  • […] unit, adipose tissue and hyalinized stroma) Terminology Initially defined as mastoma ( Beitr Pathol Anat 1928;81:1 ) Arrigoni et al. first used the term hamartoma in 1971 ( Surg Gynecol Obstet 1971;133:577 ) Also called fibroadenolipoma, adenolipoma Epidemiology[pathologyoutlines.com]
  • Epidemiology Can be hard to assess because many hamartomas are asymptomatic Incidence Depends on organ system affected Breast hamartomas are not common; estimated incidence is 0.1–0.7%.[unboundmedicine.com]
  • Epidemiology The figures given below are for hamartoma frequencies in the United States. In most cases, international frequencies are similar to those in the United States, unless stated otherwise.[emedicine.medscape.com]
  • Olaya-Contreras 1998-01-01 Full Text Available An epidemiological study was performed in Santafà de Bogotá, Colombia, with a total of 306 women enrolled, including 153 incident BC cases and 153 age-matched controls.[worldwidescience.org]
Sex distribution
Age distribution

Pathophysiology

  • Breast: 8 cases of hamartoma per 20,000 mammograms Kidney: renal hamartoma (angiomyolipoma) found in 40–80% of patients with tuberous sclerosis Etiology and Pathophysiology Functional disorder will depend on tissue of origin.[unboundmedicine.com]
  • Multiple osteochondromas have a relatively high (1-25%) incidence of malignant transformation. [5] There are many theories regarding the pathophysiology of epiphyseal osteochondromas.[emedicine.medscape.com]

Prevention

  • The author collated important benign lesions and based on peer-reviewed publications documented the relative risk of subsequent cancer to allow the patient and the clinician to institute preventative measures where possible.[books.google.com]
  • Mammary Hamartoma is difficult to prevent, because it is most likely caused by abnormal or fluctuating reproductive hormone levels. Since prevention is generally not possible, it is important to be aware of the risk factors of breast lumps.[dovemed.com]
  • Lipoma Prevention There are no specific preventive measures to avoid lipomas. Lipoma Prognosis No mortality or serious problems have been reported after removal of subcutaneous lipoma.[emedicalhub.com]
  • While there is no treatment for the condition, preventative measures can be taken to help eliminate risks. Her surgeon suggested she have a double mastectomy due to her incidence rate.[gofundme.com]
  • For neural fibrolipoma causing prominent neuropathy, open biopsy with external nerve decompression can be performed and this may prevent further nerve injury. Nevertheless, for small lesions without neuropathy, excision is the mainstay of treatment.[jmsh.ac.in]

References

Article

  1. Sevim Y, Kocaay AF, Eker T, et al. Breast hamartoma: a clinicopathologic analysis of 27 cases and a literature review. Clinics. 2014;69(8):515-523.
  2. Amir RA, Sheikh SS. Breast hamartoma: A report of 14 cases of an under-recognized and under-reported entity. Int J Surg Case Rep. 2016;22:1-4.
  3. Presazzi A, Di Giulio G, Calliada F. Breast hamartoma: ultrasound, elastosonographic, and mammographic features. Mini pictorial essay. J Ultrasound. 2015;18(4):373-377.
  4. Tatar C, Erözgen F, Tüzün S, et al. Surgical approach to breast hamartoma and diagnostic accuracy in preoperative biopsies. J Breast Health. 2013;9:186–190.
  5. Tse GM, Law BK, Ma TK, et al. Hamartoma of the breast: a clinicopathological review. J Clin Pathol. 2002;55(12):951–954.
  6. Ruiz Tovar J, Reguero Callejas ME, Aláez Chillarón AB, et al. Mammary hamartoma. Clin Transl Oncol. 2006;8(4):290-293.
  7. Erdem G, Karakaş HM, Işık B, Fırat AK. Advanced MRI findings in patients with breast hamartomas. Diagn Interv Radiol. 2011;17:33–37.
  8. Bhatia M, Ravikumar R, Maurya VK, Rai R. “Breast within a breast” sign: Mammary hamartoma. Med J Armed Forces India. 2015;71(4):377-379.

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Last updated: 2018-06-22 07:35