Retiform hemangioendothelioma of the breast: a case report and considerations for effective management

Retiform hemangioendothelioma (RHE) is a rare vascular neoplasm of intermediate malignancy, with a high frequency of local recurrence and negligible metastasizing potential. We describe a 45-year-old female who presented with a firm subcutaneous nodule in the lower-outer quadrant of the right breast. Diagnosis of RHE was confirmed based on the characteristic retiform pattern of the branching neoplastic vascular channels, as well as positivity for CD31 and negativity for D2-40 markers. The patient was successfully treated with wide local excision of the tumor with clear surgical margins. The resulting defect was reconstructed with local tissue displacement and direct closure. RHE must be considered in the differential diagnosis of skin vascular tumors, while histopathological and immunohistochemical examination remain core to the diagnosis. Wide local excision with clear margins is the treatment of choice, whereas radiotherapy and, more rarely, chemotherapy can be considered in the event of recurrence and in unresectable cases.