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Papillary Endothelial Hyperplasia (Masson's Tumor) of the Breast: Radiologic-Pathologic Correlation.

Elizabeth G Lane1, Andy V Phan2, Lana Malekan3

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Summary

Papillary Endothelial Hyperplasia (PEH), a rare benign breast lesion, is often mistaken for angiosarcoma. This study reviews 31 cases, highlighting its unique histopathology and the need for surgical excision due to diagnostic challenges.

Keywords:
breast MRI techniquesbreast pathologybreast ultrasoundmammography including tomosynthesis

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Area of Science:

  • Pathology
  • Oncology
  • Vascular Biology

Background:

  • Papillary Endothelial Hyperplasia (PEH), also known as Masson's Tumor, is a rare benign vascular lesion.
  • PEH is hypothesized to be a reactive process, potentially a variant of organizing thrombus.
  • Its occurrence in the breast is infrequent, posing diagnostic challenges.

Purpose of the Study:

  • To review the histopathological features of Papillary Endothelial Hyperplasia (PEH) in breast tissue.
  • To contribute additional cases to the existing literature on PEH.
  • To emphasize the importance of differentiating PEH from malignant lesions like angiosarcoma.

Main Methods:

  • Literature review of 28 previously reported cases of PEH in the breast.
  • Detailed histopathological analysis of three newly identified cases of PEH.
  • Comparison of imaging and histopathological findings.

Main Results:

  • PEH presents as circumscribed masses and/or microcalcifications on imaging.
  • Histopathology reveals proliferating endothelial cells within organizing hemorrhage and fibrin.
  • Papillary structures with a hyalinized fibrin core are characteristic.
  • PEH can histologically mimic angiosarcoma, especially in small biopsies.

Conclusions:

  • Papillary Endothelial Hyperplasia is a rare, benign vascular lesion of the breast.
  • Distinguishing PEH from angiosarcoma is crucial due to their differing clinical management.
  • Surgical excision is the recommended treatment for PEH to ensure accurate diagnosis and prevent potential misdiagnosis.