ANGIOMIOLIPOMA DE LA MAMA
ANGIOMYOLIPOMA OF THE BREAST
Giorgio Gherardi, M.D., Andrea Baiocchini, M.D., Piero Di Zitti, M.D.
RESULTADOS
RADIOLOGIC FINDINGS
Review of X-rays mammogram revealed a 3.5 cm well demarcated lump of with a density similar to that of adipose tissue. A scintimammography using 99mTc-Tetrofosmin demonstrated the lesion to be fairly well vascularized.
PATHOLOGIC FINDINGS
Surgical specimen consisted of a breast quadrant measuring 12x6.5x5 cm with a portion of overlying skin measuring 5x1 cm. Breast parenchyma contained a well circumscribed nodule measuring 3.4x2.5x2.2 cm, rubbery in consistency, with a yellowish to grey cut surface, without evident necrosis or hemorrhage. Gross examination of the remaining mammary tissue was otherwise unremarkable. On histologic examination the lesion consisted of a nodular growth of mature adipose tissue, admixed to numerous blood vessels with the features of small arteries, capillaries, and venules, and smooth muscle cells with a prevalent perivascular arrangement (Fig.1). The nodular growth appeared to dissociate mammary lobules and ducts and showed no lobulation. Fat cells appeared as mature adipocytes with little variation in size and shape and regularly shaped nuclei; no lipoblasts were detected. Small arteries were thick-walled and tortuous (Fig. 2). They frequently displayed subintimal fibrosis with little and fragmented or no elastica, as shown by Weigert stain for elastic fibers (Fig. 3). Smooth muscle cells showed a prevailing perivascular arrangement with a disorderly fascicular arrangement (Fig. 2). In areas, they proliferated as solid sheets with a loosely arranged, or somewhat storiform, configuration. Smooth muscle cells were mostly spindle-shaped with elongated and blunt ended nuclei. Nuclear pleomorphism was mild and focal; chromatin frequently showed a coarsely granular pattern with small nucleoli. No mitoses were observed. When stained with Masson’s trichrome stain most of smooth muscle cells showed cytoplasmic fuchsinophylia. They showed positive immunostaining for smooth muscle actin (Fig. 4) and desmin. FVIII-rAg immunostaining accentuated blood vessel endothelia and was not expressed by any other cellular component. Immunostaining for the human melanoma associated antigen HMB-45 gave negative results.
Giorgio Gherardi, M.D., Andrea Baiocchini, M.D., Piero Di Zitti, M.D.
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