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Arch Surg. 2007;142(2):202.

Answer: Mammary Hamartoma
The mass was extirpated by a round block incision, although the nipple-areola complex had a large diameter (7 cm), and a vertical prolongation had to be done to allow the extraction of the giant tumor (13 cm x 14 cm; 740 g). Pathologic examination revealed a breast hamartoma.

Breast hamartomas are uncommon benign lesions. They are well-circumscribed tumors composed of a variable mixture of epithelial elements, fat, and fibrous tissue.¹ As it did in our case, a hamartoma may appear as a homogeneously dense, well-circumscribed mass, which can vary in appearance from a classically described mass to an encapsulated, mixed, fatty-fibroglandular mass.² The role of fine-needle aspiration cytology and core-needle biopsy in making the diagnosis is limited and requires clinical and radiologic correlation to avoid underdiagnosis. In our case, the histologic diagnosis by core-needle biopsy was pseudoangiomatous stromal hyperplasia; this histologic feature needs to be distinguished from another benign and malignant lesion, which sometimes has a similar cytologic apperance.³ The incidence rate of pseudoangiomatous stromal hyperplasia in hamartomas ranges from a high incidence of 71%⁴ to a low incidence of 16%.⁵ Hamartomas with associated pseudoangiomatous stromal hyperplasia may show marked vascularity; this was clearly demonstrated in magnetic resonance imaging.^{4, 6} Magnetic resonance imaging of the breast hamartoma revealed a tumor with intermediate signal intensity on both T1- and T2-weighted images, and showed a time-signal intensity curve with a slow and progressive enhancement; dynamic contrast enhancement suggested a benign lesion.⁷ Usually hamartomas are described as slow-growing lesions; in our case, the mass doubled its size in 10 months. In this situation we had to make a differential diagnosis of a malignant mass; other possible diagnoses included a circumscribed fibrocystic lesion, fibroadenoma, and cystosarcoma phyllodes. The size and weight of the tumor in our case led us to determine it was a giant hamartoma.⁸ Three months after the removal of the tumor the healthy breast tissue expanded and the breast recovered its usual appearance.

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AUTHOR INFORMATION

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Correspondence: Pilar Alonso-Bartolomé, MD, Radiology Division, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla, Santander, Spain 39008 (mpalonso{at}humv.es).

Accepted for Publication: January 31, 2006.

Author Contributions: Study concept and design: Hernanz, Alonso-Bartolomé, Garijo, Vega, Alvarez, and Gómez-Fleitas. Acquisition of data: Hernanz, Alonso-Bartolomé, and Ortega. Analysis and interpretation of data: Hernanz, Alonso-Bartolomé, and Ortega. Drafting of the manuscript: Hernanz and Alonso-Bartolomé. Critical revision of the manuscript for important intellectual content: Hernanz, Alonso-Bartolomé, Garijo, Vega, Ortega, Alvarez, and Gómez-Fleitas. Administrative, technical, and material support: Hernanz, Alonso-Bartolomé, Garijo, Vega, Ortega, and Alvarez. Study supervision: Gómez-Fleitas.

Financial Disclosure: None reported.

REFERENCES

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1. Charpin C, Mathoulin MP, Andrac L; et al. Reappraisal of breast hamartomas: a morphological study of 41 cases. Pathol Res Pract. 1994;190:362-371. ISI | PUBMED 2. Georgian-Smith D, Kricun B, McKee G; et al. The mammary hamartoma: appreciation of additional imaging characteristics. J Ultrasound Med. 2004;23:1267-1273. FREE FULL TEXT 3. Brogi E. Benign and malignant spindle cell lesions of the breast. Semin Diagn Pathol. 2004;21:57-64. FULL TEXT | ISI | PUBMED 4. Fisher CJ, Hanby AM, Robinson L; et al. Mammary hamartoma: review of 35 cases. Histopathology. 1992;20:99-106. ISI | PUBMED 5. Daya D, Trus T, D’Souza TJ; et al. Hamartoma of the breast, an underrecognized breast lesion: a clinicopathologic and radiographic study of 25 cases. Am J Clin Pathol. 1995;103:685-689. ISI | PUBMED 6. Deshmukh H, Prasad S, Patankar T. A giant vascular hamartoma of the breast in a child. J Postgrad Med. 1997;43:50-51. PUBMED 7. Kievit HCE, Sikkenk AC, Thelissen GRP, Merchant TE. Magnetic resonance image appearance of hamartoma of the breast. Magn Reson Imaging. 1993;11:293-298. FULL TEXT | ISI | PUBMED 8. Weinzweig N, Botts J, Marcus E. Giant hamartoma of the breast. Plast Reconstr Surg. 2001;107:1216-1220. FULL TEXT | ISI | PUBMED