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Reappraisal of breast hamartomas. A morphological study of 41 cases
C Charpin1, M P Mathoulin, L Andrac
1Department of Pathology Hopital de la Timone, Marseille, France.
Insights
Mammary hamartomas, a type of benign breast tumor, are often underdiagnosed. These lesions are characterized by a mix of stromal and epithelial tissue, differing from typical adenofibromas.
Area of Science:
- Pathology
- Radiology
- Oncology
Background:
- Mammary hamartomas are underrecognized breast lesions.
- They represent a small percentage of benign breast tumors and biopsies.
- Diagnosis often relies on a combination of clinical, radiological, and pathological findings.
Purpose of the Study:
- To report the incidence and characteristics of mammary hamartomas.
- To differentiate hamartomas from other benign breast lesions.
- To clarify the diagnostic criteria for mammary hamartomas.
Main Methods:
- Histological examination of 5,834 breast biopsies over 7 years.
- Analysis of clinical and radiological findings for 41 diagnosed hamartomas.
- Comparison of macroscopic and microscopic features with other benign breast tumors.
Main Results:
- Hamartomas constituted 1.2% of benign lesions and 4.8% of benign breast tumors.
- Clinical presentation typically involved a painless palpable lump.
- Mammography showed circumscribed density; histology revealed a mix of stromal and epithelial components, often with adipose tissue and fibrohyaline changes.
- Hamartomas showed lobulated architecture and pushing borders, distinct from adenofibromas.
Conclusions:
- Mammary hamartomas are distinct benign breast lesions with specific clinical, radiological, and pathological features.
- Diagnosis requires integrating multiple criteria, often as a diagnosis of exclusion.
- These lesions are considered a result of breast dysgenesis rather than a neoplastic process.
Abstract:
Mammary hamartomas are breast disorders currently underestimated and not well recognized. Forty-one hamartomas diagnosed among 5,834 breast biopsies, histologically examined during the last 7 years, are reported. Hamartomas accounted for 1.2% of benign lesions and 4.8% of benign breast tumors. Clinically, hamartomas were revealed by breast palpable lump, usually painless. Typically, but inconsistently, mammography showed sharply circumscribed density, separated from adjacent normal breast by a thin radiolucent zone. Macroscopically, hamartomas were slightly larger and softer than common adenofibromas, were well limited, whitish, pinkish and fleshy, with yellow islands of fat tissue. Histologically, hamartomas exhibited pushing borders with a pseudoencapsulation, and consisted of a combination of variable amount of stromal and epithelial components. Stromal components mainly consisted in a prominent fibrohyalin feature usually associated to small islands of adipose tissue and edematous changes. Epithelial structures showed variable features of benign breast disease. The overall architecture was lobulated but not nodular. The histological diagnosis was mainly a diagnosis of exclusion and hamartomas diagnosis relies on clinical, radiological and pathological criteria. Hamartomas result more from breast dysgenesis than from tumorous process.