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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 × 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.
The Editor welcomes contributions to the Image of the Month. Manuscripts should be submitted via our online manuscript submission and review system (http://manuscripts.archsurg.com). Articles and photographs accepted will bear the contributor's name. Manuscript criteria and information are per the Instructions for Authors for Archives of Surgery (http://archsurg.ama-assn.org/misc/ifora.dtl). No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.
Correspondence: Pilar Alonso-Bartolomé, MD, Radiology Division, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla, Santander, Spain 39008 (firstname.lastname@example.org).
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.
Image of the Month—Diagnosis. Arch Surg. 2007;142(2):202. doi:10.1001/archsurg.142.2.202
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