A Suspicious Breast Lesion Detected by Dynamic Contrast-Enhanced MRI and Pathologically Confirmed as Capillary Hemangioma: a Case Report and Literature Review
We present an asymptomatic 30-year-old female Asian patient who gave birth 2 years ago. There is no history of hormone intake or family history of breast cancer. Ten months ago, the patient underwent breast palpation, mammography, and ultrasound (for the first time). The results present a nodule (1.6 × 1.2 × 0.9 cm3) locating on the right breast at 7 o'clock position with an oval shape, clear boundary, internal hypoechoic, and calcifications. Radiologists classify the lesion as BIRADS category 3. The patient requested the lesion to be surgically removed. This lesion was pathologically confirmed as breast fibroadenoma with calcification.\nBefore the surgery, MR scanning (GE Signa HDxt 3.0T) was performed according to the recommendation of a clinician. DCE-MRI did not detect enhancement of the mass (breast fibroadenoma with calcification). Surprisingly, a new small nodule (0.7 × 0.5 × 0.4 cm3) was found at the upper outer quadrant of the right breast. MRI presented an oval mass located on the mammary gland, anterior to the superficial pectoralis fascia with a well-defined margin. An unenhanced T1-weighted image did not display the mass well (), while a T2-weighted image showed the mass area of high signal (). DCE-MRI presented a strong homogeneous enhancement of the mass (). The region of interest was obtained from the enhancing area of the lesion to generate a time-signal intensity curve. The curve was classified as washout type (). Radiologists classify this mass as BI-RADS category 4B. Ultrasound was then carefully performed on the patient (for the second time), showing an oval nodule with a well-defined margin and internal hypoechoic (). Color Doppler flow imaging presented rich blood flow signals ().\nThis suspicious breast lesion was strongly advised to be surgically removed. Before surgery, two experienced radiologists made a surface marker for the lesion based on the DCE-MRI and ultrasound presentation. In the operating room, the surgeon confirmed the lesion again by ultrasound (for the third time) before the surgery. The lesion was pathologically confirmed as breast capillary hemangioma, which is a benign vascular tumor and rarely seen in the breast (). Immunohistochemical staining showed strong positive CD34 expression and negative CK expression of the lesion, which supported our diagnosis ().