Vascular tumors of the breast. III. Angiomatosis

This report describes three female patients who were treated for diffuse vascular lesions of the breast. The lesion was congenital in one patient. Two were adults (40 and 59 years old). Each presented with a mass within the breast. Microscopically, the tumors were composed of vascular channels growing diffusely in breast parenchyma. The vessels were lined by flat, inconspicuous endothelium with sparse supporting mural tissue virtually devoid of smooth muscle. The lesions consisted of hemangiomatous (erythrocyte-containing) and lymphangiomatous (seemingly empty) channels with lymphoid aggregates. This combination of a mixed pattern of vessels and diffuse growth is similar to that seen in lesions that have been called angiomatosis in other anatomic sites. Because the microscopic distinction between very orderly angiosarcomas and angiomatosis may be difficult, complete excision of the tumor is necessary. For bulky lesions, this may require mastectomy. In one patient congenital angiomatosis has persisted and recurred twice in the mammary region over 39 years. The other two patients remain well 3 years after local excision and 2 years and 4 months after mastectomy, respectively. Angiomatosis of the breast has not exhibited clinically malignant behavior since no metastases have been observed.     

Vascular tumors of the breast. II. Perilobular hemangiomas and hemangiomas

Nearly 100 vascular tumors of the breast have been studied. Sixty-two were angiosarcomas lesions. Twenty-four patients with mammary hemangiomas are the subject of this report. Five of 11 microscopic perilobular hemangiomas, not clinically apparent (2 mm or less), were atypical and had nuclear hyperchromasia or focal anastomoses among vascular channels. Whether treated by excision or mastectomy, all 11 patients remain well with follow-up of up to 10 years. Fourteen clinically or grossly apparent macroscopic hemangiomas (0.3-2.5 cm) included eight characterized as cytologically atypical. With one exception, lesions designated hemangiomas were well circumscribed and tended to be divided into lobules. In more than half, origin from large, non-neoplastic "feeding" vessels that were seen branching into the lesion was demonstrated. Whether treated by excision or mastectomy, no hemangioma has recurred after follow-up, up to 5 years in some cases. The diagnosis of vascular tumors of the breast requires thorough microscopic study of the entire lesion. The majority are angiosarcomas. However, about one-third constitute a spectrum of apparently benign and atypical lesions, in which the single largest group are perilobular hemangiomas and hemangiomas. Size appears to be an important characteristic for distinguishing hemangiomas from angiosarcomas, as few lesions larger than 2 cm qualify as hemangiomas, whereas angiosarcomas are rarely smaller than 2 cm. It is possible that atypical perilobular hemangiomas or atypical hemangiomas are precursors to angiosarcoma, but this relationship remains to be demonstrated.     

Vascular tumors of the breast. V. Nonparenchymal hemangiomas of mammary subcutaneous tissues

Nine patients with vascular lesions of the mammary subcutaneous tissue were studied. All were women who ranged in age from 20 to 76 years (average 53 years). The lesions were angiolipomas (three cases), cavernous hemangiomas (three cases), and one example each of juvenile hemangioma, venous hemangioma, and papillary endothelial hyperplasia. The average size of these tumors was 1.8 cm (range, 0.8-3.2 cm). Only one of the excisional biopsy specimens contained breast tissue, and in this case the hemangioma was also extra parenchymal. With follow-up available for seven patients ranging from 5 months to just over 5 years (average 29 months), there were no recurrences. Subcutaneous hemangiomas of the breast do not differ appreciably in their clinical or pathological features from comparable lesions at other anatomic sites. Although mammary subcutaneous hemangiomas are benign and are not prone to recurrence or progression to angiosarcoma, complete excision is recommended to exclude the possibility of an underlying angiosarcoma.     

Case of testicular venous hemangioma

A case of a testicular venous hemangioma is presented. A 65-year-old man complained of left testicular swelling. Physical examination and ultrasonography revealed a 2.0 x 1.6 x 1.5 cm roundish, well demarcated isoechoic elastic hard tumor in the left testis. No other abnormal findings including tumor markers were observed. Since preoperative examination did not rule out malignancy, we performed left high orchiectomy. Pathological diagnosis was a venous hemangioma of the left testis. Venous hemangioma is a rare entity among the testicular solid lesions.     

Synovial venous hemangioma of the knee joint

Summary Hemangiomas rarely involve joints and less than 100 synovial hemangiomas have been reported. A case of a localised, intermediate type of venous angioma in the kneejoint causing severe knee pain is reported here, and the characteristic features are discussed. Arthroscopy is suggested as a valuable diagnostic procedure in finding and examining such tumors.

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Zusammenfassung Hämangiome sind selten in Gelenken zu finden, bisher sind weniger als 100 Fälle eines synovialen Hämangioms veröffentlicht worden. Hier wird von einem Fall eines intermediären venösen Hämangioms im Kniegelenk mit heftigen Beschwerden berichtet und charakteristische Gesichtspunkte diskutiert. Die arthroskopische Untersuchung wird als wertvolle diagnostische Möglichkeit zur Diagnosesetzung vorgeschlagen.

     

Monstrous venous hemangioma of the retroperitoneum. Problems in diagnosis]

The venous haemangioma is defined as a benign tumor consisting of vein-like vessels. The preoperative diagnosis and its inherent problems are illustrated by a coincidentally diagnosed monstrous haemangioma of the retroperitoneal space in a twenty year old patient. With respect to our patient, X-ray, computed tomography and angiography all failed as diagnostic tools. Only the use of Doppler-sonographic flow signals suggested the presence of an haemangioma. The morphology, prognosis and clinical significance of blood vessel tumors are manifold. The most important differential diagnoses of venous haemangioma are the cavernous and the capilliary haemangioma. The venous haemangioma distinguishes itself through the presence of blood vessel walls. Haemangiomas are common benign tumors. They can grow to monstrous proportions whilst remaining undetected. Thus the patient is endangered of bleeding to death because of trivial injuries. The therapy of choice consists in total surgical excision. In unclear clinical situations with respect to preoperative diagnosis especially amongst young adults, the diagnosis of an hemangioma should be taken into amount.     

A case of venous hemangioma in the mediastinum

A thirteen-year-old boy was admitted to our hospital for further evaluation of abnormal shadow on chest film with a low grade fever. Laboratory findings revealed within normal value except for CRP. Chest film showed a smooth round mass in right middle mediastinum. In the CT scan, it was a well-defined round mass with low density in contact with sternum. With angiography, it had no relation to the great vessels. At operation, a coagulation was on the surface of a tumor. The tumor adhered to sternum and parietal pleura firmly and to aortic arch and thymus partly. But it was removed with ease "en bloc". It was dark red in color and upper part of was cystic, and lower massive. The tumor measured 9.5 x 5.0 x 5.5 cm and weighted 320 g. Histopathological findings demonstrated venous hemangioma proved by Masson trichrome stain.     

Vascular tumors of the abdominal wall

BACKGROUND: Vascular tumors of the abdominal wall are rare, benign congenital malformations that may cause pain or cosmetic disfigurement and are of significance for their ability to mimic more clinically aggressive tumors. There have been no previous reports of vascular tumors of the abdominal wall. This investigation reports the clinical presentation, diagnosis, and treatment of three patients with vascular tumors of the abdominal wall. METHODS: Magnetic resonance angiography (MRA) was used to identify feeding and draining vessels and to aid in operative planning for two patients; in a third patient, standard magnetic resonance imaging revealed the feeding vessels. RESULTS: MRA accurately identified the feeding and draining vessels and aided in operative planning, thus facilitating complete tumor resection. To date, patients have not experienced tumor recurrence. CONCLUSIONS: These cases suggest that MRA can be employed as a noninvasive imaging technique and should be the standard preoperative modality to plan the operative approach to vascular tumors of the abdominal wall.     

Primary smooth muscle tumors of venous origin.

Vein tumors are rare, difficult to diagnose, and usually malignant. We have encountered three: a leiomyoma of the jugular vein and leiomyosarcomas of the saphenous vein and inferior vena cava (IVC). The leiomyoma was lost to follow-up, the saphenous vein leiomyosarcoma survived nine years, and the leiomyosarcoma of the IVC is six months without recurrence. Half of venous leiomyosarcomas arise in the IVC, predominately in women over 50 years of age. Surgical excision is the treatment of choice since malignant or benign status cannot be determined operatively. Resection should include a segment of the original vessel. This poses problems in the IVC when the renal veins require sacrifice. Right renal vein interruption mandates nephrectomy. Edema following IVC resection is evaluated. The incidence is lower than anticipated when resection is for tumor if there is no history of phlebitis. The IVC was reconstructed with a composite autograft but this is not now recommended. Despite significant local recurrences or distal metastases, cure or long-term palliation can often be achieved. Radiation and chemotherapy do not improve survival or prevent recurrence.     

Malignant venous tumors of the limbs. Apropos of 6 cases

The authors report six personal cases of malignant venous tumours of the limbs, tumour pathology of the inferior vena cava being excluded from this study. Diagnostic features are described together with the various therapeutic possibilities. This discussion forms the basis of a review of the worldwide literature, but stresses two problems which determine the prognosis: that of diagnosis, which in the majority of cases is very late, and that of their prognosis, which remains somber because of their tendency to metastasize by blood-borne spread and that of locoregional recurrences. Finally, the authors suggest a three stage classification, taking into account not only macroscopic pathological features but also the results of the various special investigations which have led to the diagnosis. Prognostic correlation based upon the features involved in this classification is entirely satisfactory.     

Vascular tumors of the hand and forearm

Although blood vessel tumors are rare, they are frequently encountered in the hand and forearm, being the fourth most common tumor of the hand. The treating physician should be aware of the acquired, traumatic, and congenital vascular tumors that are so prevalent in this area.