Breast hamartoma is a rare benign tumor of the breast, and it is classified based on the variable tissue components. It is more common during the lactating period and premenopausal period. Bilateral breast hamartoma is rarely reported in the literature. It might create diagnostic difficulty based on fine-needle aspiration cytology and core needle biopsy. Radiological investigation sometimes might have overlaying findings with malignant disease. It is always better to undergo an excision biopsy for the confirmation of the diagnosis.
Keywords: Benign tumor, breast hamartoma, excision biopsy, fibroadenolipoma, phyllodes tumor
| Introduction|| |
Breast hamartoma is a rare benign tumor that consists of a variable amount of breast tissue, adipose tissue, and fibrous tissue. It is classified based on the tissue character: (1) fibroadenolipoma contains breast tissue, fibrous tissue, and adipose tissue; (2) myeloid hamartoma contains breast tissue, fibrous tissue, and smooth muscle; and (3) chondrolipoma contains breast tissue, fat, and chondroid element. Breast hamartoma is a mostly unilateral disease rather than bilateral disease.
| Case Report|| |
A 45-year- old female was admitted with a complaint of a lump in both breasts for 6 months duration. She also complained of pain in both breasts for 4 months duration. There was no family history of the breast or ovarian malignancy in the family. Physical breast examination showed a lump of 8 cm × 6 cm upper outer quadrant of the right breast and a 6 cm × 5 cm lump upper and outer quadrant of the left breast. The lump was firm to hard in consistency. The lump was not fixed to any underlying structure. There was no evidence of axillary lymphadenopathy on either side of the axilla.
Ultrasound examination of both breasts showed a lump of 8 cm × 6 cm on the right side and 6 cm × 5 cm on the left side [Figure 1]. There was no evidence of axillary lymphadenopathy. Image-guided trucut biopsy showed that the tumor is composed of cohesive clusters as well as a large number of dispersed cells and naked nuclei. There are predominantly stromal cells and few clusters of epithelial and myoepithelial cells. There is mild pleomorphism noted in the epithelial clusters. Based on the above features, she was diagnosed with a bilateral phyllodes tumor. Contrast computed tomography of the chest showed no evidence of chest involvement or lung involvement. The patient underwent wide local excision [Figure 2]. The postoperative specimen showed a lump of 8 cm × 6 cm on the right side and 6 cm × 5 cm on the left side [Figure 3]. Postoperative histology showed bilateral noncapsulated nodular lesions composed of well-formed breast ducts and lobules with benign epithelial and myoepithelial cells with intervening fibrous stroma and mature adipose tissue. There was no evidence of atypia or necrosis noted. Based on the features, she was diagnosed with bilateral breast hamartoma [Figure 4]. The patient is followed up for more than 3 years without any evidence of recurrence.
|Figure 1: Ultrasound breast showing areas of hypoechoic and isoechoic areas in the right breast|
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|Figure 3: Postoperative cut open section showing both right and left breast mass which is yellowish-white in nature|
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|Figure 4: Postoperative histology showing a variable amount of breast tissue along with fibrofatty tissue|
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| Discussion|| |
The reported incidence of breast hamartoma ranges from 0.04% to 1.1%. Bilateral breast hamartoma is even rare. There is no confirmed etiopathogenesis for breast hamartoma. Few studies showed that pregnancy and lactation are the causes of breast hamartoma. However, the study by Helvis et al. showed that breast hamartoma could arise even in nulliparous women. Most breast hamartoma is unilateral and asymptomatic. Bilateral breast hamartoma is very rare. Hamartoma with more fat components may not be detected easily during an initial clinical examination. Hamartoma with fibrous components may mimic fibroadenoma or breast carcinoma.
Mammography might show nonhomogenous breast tissue due to the variable degree of presence of fat and breast parenchyma. The shape of the mass in mammography varies from round to oval. Some breast hamartoma might show classical “a piece of cut sausage” due to the presence of variable fat and breast parenchyma. In some cases, there might be an area of translucency around the hamartoma due to the presence of a pseudocapsule around the lesion. Ultrasound might detect breast hamartoma, but the chance of misdiagnosis is quite high. Most of the hamartomas show isoechoic or hypoechoic lesions with regular margins. There may be areas of the hyperechoic lesion due to the presence of high fibroglandular lesion.
Fine-needle aspiration cytology is not conclusive of breast hamartoma because it might show normal breast tissue. In most of the reports, core needle biopsy failed to confirm the diagnosis. Open excision biopsy is the confirmatory investigation for breast hamartoma. The management depends on histology. Benign phyllodes tumor requires wide local excision, whereas malignant lesion requires modified radical mastectomy. Hence, proper preoperative diagnosis is mandatory. There are case reports of breast hamartoma developed into breast carcinoma. Hence, careful examination of histology might be helpful to decide the line of management.
Postoperative histology might help us to decide future treatment. An excision biopsy is the only way to confirm the diagnosis of breast hamartoma. All suspected case requires wide local excision.
| Conclusion|| |
Breast hamartoma should be considered one of the differential diagnoses of bilateral breast lesions. Most of the time, diagnosis is difficult based on fine-needle aspiration cytology or core needle biopsy. Sometimes, radiological investigations fail to confirm the diagnosis of breast hamartoma. It is always better to do an excision biopsy of the lesion to confirm the diagnosis, and it can reduce future complications such as breast carcinoma.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
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