Presentation
Painless, unilateral retroareolar breast lump discovered on self-examination. Anisomastia. Referred for breast ultrasound.
Patient Data
Retroareoalar ovoid mass, with well-defined margins. The internal architecture is composed of a mixture of isoechoic fat and echogenic glandular elements in a disorganized fashion. The lesion is compressible and too large to measure on ultrasound. There are focally dilated ducts in the axillary tail, likely due to compression from the hamartoma.
Right breast MLO was performed to confirm a suspected diagnosis of hamartoma. ACR type C breast composition.
Large retroareolar breast hamartoma with breast within a breast appearance, containing both fat and glandular components
The lesion is ovoid shaped with well-defined margins and a thin imperceptible capsule.
Case Discussion
Radiological implications:
ultrasound was chosen as the initial imaging modality considering the patient’s age, and single view MLO was done to confirm the diagnosis
given the typical pathognomonic appearance, diagnostic uncertainty is rarely problematic
benign lesion allocated to BIRADS 2
Clinical implications:
there have been previous variations in nomenclature, but since 1971, “Hamartoma” has been the acceptable term. As the other acceptable term, fibroadenolipoma, suggests, it contains fibrous, glandular, and adipose tissue which are all normal breast tissue types
hamartomas are most common in the pre- 1 and perimenopausal 2 periods
hamartomas are benign lumps that can enlarge with the rest of the breast tissue like in pregnancy and lactation and will consequently also regress after menopause
this is a slow-growing lesion that may be underdiagnosed as it radiologically appears like normal breast tissue in the early stages 3. Histological and cytological features are also often similar to normal breast tissue 2
histology may also show mammary ducts, smooth muscle, and hyaline cartilage 2
physicians may hopelessly chase a diagnosis with multiple biopsies, due to seemingly normal microscopic appearance 1,2. Radiological studies play an important role in the identification of this breast lesion
very rarely malignancy can arise from within the glandular component of the Hamartoma 1
management depends on the institution but generally consists of reassurance and watchful waiting with radiological follow-up 3. In cases of unacceptable asymmetry or patient dissatisfaction, surgical excision may be considered. Patients should be counseled on the risks of surgery, anesthesia, and disfiguration of the breast before surgery. After clear margin excision of the lesion, there is no recurrence of the hamartoma 2
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