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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 44-46

Large Hamartoma occupying the whole breast: Creates a Diagnostic Challenge


Assistant Professor and Consultant, ABGS (Arab Board General Surgery), Breast and Endocrine Unit, General Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication26-Sep-2019

Correspondence Address:
Amal Abdullah Abdulkareem
Breast and Endocrine Unit, College of Medicine, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SJL.SJL_3_19

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  Abstract 

Hamartoma is detected in the breast during screening of breast asymmetry or discovered pathologically in combination with other breast pathologies. Hamartoma should be considered one of the differential diagnoses of breast asymmetry, especially for young women, where mammogram is not frequently ordered or if the patient complains of significant breast asymmetry with no clearly evident breast mass by physical examination and normal breast ultrasound. Hamartoma is detected by mammogram as “'breast within a breast.” Ultrasound can diagnose small localized hamartoma and fine-needle aspiration or core needle biopsy of no significant help in diagnosis of isolated hamartoma not assonating with other pathologies. Mammogram and breast magnetic resonance imaging (MRI) are of great help in diagnosing hamartoma especially if it is large occupying the whole breast. Awareness of isolated hamartoma as a cause of breast asymmetry with the help of mammogram or MRI of the breast will lead to early diagnosis and treatment and avoid patient suffering of undiagnosed breast hamartoma.

Keywords: Breast, hamartoma, large


How to cite this article:
Abdulkareem AA. Large Hamartoma occupying the whole breast: Creates a Diagnostic Challenge. Saudi J Laparosc 2019;4:44-6

How to cite this URL:
Abdulkareem AA. Large Hamartoma occupying the whole breast: Creates a Diagnostic Challenge. Saudi J Laparosc [serial online] 2019 [cited 2019 Nov 15];4:44-6. Available from: http://www.saudijl.org/text.asp?2019/4/1/44/255882


  Introduction Top


Hamartoma from Greek, hamartia, meaning fault, defect, and oma denoting tumor or neoplasm.[1]

It is uncommon and has uncertain origin breast tumor that contains normal breast parenchyma including fibrous, fibrocystic, and adipose tissue,[2],[3] initially defined as mastoma (Beitr Pathol Anat 1928;81:1).

Arrigoni et al.first used the term hamartoma in 1971 (Surg Gynecol Obste 1971;133:577).[4]

Breast asymmetry from nipple to inframammary fold found in 59.6%.[5]

Minor breast asymmetry is quite common, but significant breast asymmetry needs to be investigated carefully to rule out underlining pathologies. With the presence of large hamartoma which occupying the whole breast with the same texture of the other breast can be mistaken as normal larger asymmetric breast. Hamartoma may be discovered during imaging performed for other reasons.[6] The increasingly widespread use of mammographic screening the diagnosis of breast hamartoma is on rise.[6] Small hamartoma can be detected by physical examination and by ultrasound as a breast mass. However, large isolated hamartoma not associating with other pathologies and occupying the whole breast creates a diagnostic challenge where fine-needle aspiration cytology (FNAC) and core biopsy of no role in such cases.[7]


  Case Report Top


A 38-year-old female seek medical advice several times for 9 years for her right breast asymmetry. All the time, she was assured by her physician that there is no pathology and her ultrasound reported as normal breast tissue with increase in her breast size. She was referred to our clinic for the second opinion. The patient was seen and evaluated in the clinic. She was a young healthy woman with clear breast asymmetry. Her right breast doubled the size of her left breast with a soft mobile mass almost occupying all her right breast. The patient sent for breast ultrasound reported as having normal breast tissue with no abnormal pathology. The case was discussed with a breast imaging radiologist. Mammogram was performed which showed clear mass occupying the whole breast with a feature suggestive of hamartoma [Figure 1].{Figure 1}

The patient underwent surgical excision of her right well-circumscribed breast mass measuring 15 cm × 12.5 cm [Figure 2]. In the pathology report the encapsulated fibrocystic changes. Apocrine metaplasia no malignant feature.{Figure 2}

Postoperative follow-up, the patient almost has symmetric breast with no more heaviness in her right breast; she has normal size symmetric breast in 2 years of follow-up [Figure 3].{Figure 3}


  Discussion Top


Breast hamartoma is relatively rare entity. It may become large and cause breast asymmetry.[8] Breast asymmetry is common complain among young woman Physical exam and clinical evaluation are assuring, but significant breast asymmetry or presence of mass indicate full clinical, radiological and pathological evaluation. Hamartoma don't possess specific diagnostic histological feature, the role of FNAC and core needle biopsy in making the diagnosis is limited and requires clinical and radiological correlation to avoid under diagnosis.[2],[7] The pathogenesis is still poorly understood.[2],[9] Hamartoma misdiagnosed as Lipoma, fat necrosis.[3] Trial to classify hamartoma into specific categories based on their histological appearance are not generally accepted by most authorities.[3] Fibroadenolipoma or lipoadenofibroma or adenolipoma [4],[10] this is due to benign proliferation of fibrous glandular and fatty component of the breast surrounded by connective tissue capsule.[8],[11] Adenolipoma and encapsulated fibrocystic changes were categories created by Jones et al.[3]

Our patient falls histologically into the encapsulated fibrocystic changes, which can be missed histologically and sonographically. Both ultrasound and histopathology will be variable and nonspecific.[2],[10] Mammogram has the characteristic feature of “breast within the breast” or “ a slice of the sausage” appearance.[2]

The radiological feature by mammogram (well-circumscribed rounded or oval mass surrounded by thin capsule, comprising both fat and soft tissue internal densities).[2],[8] Awareness of isolated hamartoma as a cause of breast asymmetry with the help of mammogram or magnetic resonance imaging of the breast will lead to early diagnosis and treatment. Association of hamartoma with other pathologies, e.g., phyllodes or lipoma or even malignancy,[12] can make the diagnosis more easier. “Many authors consider hamartoma to be underdiagnosed."[7]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Seth R, Mir S. Hamartoma. Medscape; updated 3 October, 2017.  Back to cited text no. 1
    
2.
Barbaros U, Deveci U. Breast hamartoma: A case report. Act Chir Belg 2005;105:658-9.  Back to cited text no. 2
    
3.
Rocychowdhury M. Breast Nonmalignant benign Tumors/Changes Hamartoma of Breast. Ohio State University. Available from: http://www. Pathologyoutlines.com/topic/breasthamartoma.html. [Last accessed on 2019 Feb 13].  Back to cited text no. 3
    
4.
Amir RA, Sheikh SS. Breast hamartoma: A report of 14 cases of an under-recognized and under-reported entity. Int J Surg Case Rep 2016;22:1-4.  Back to cited text no. 4
    
5.
Gabriel A. Incidence of breast and chest wall Asymmetry: 4Dphotography. Aesthetic Surg J 2011;31:506-10.  Back to cited text no. 5
    
6.
Presazzi A, Di Giulio G, Calliada F. Breast hamartoma: Ultrasound, elastosonographic, and mammographic features. Mini pictorial essay. J Ultrasound 2015;18:373-7.  Back to cited text no. 6
    
7.
Tse GM, Law BK, Ma TK, Chan AB, Pang LM, Chu WC, et al. Hamartoma of the breast: A clinicopathological review. J Clin Pathol 2002;55:951-4.  Back to cited text no. 7
    
8.
Cazorla S, Arentz C. Breast Hamartomas – Differential consideration in slow developing breast asymmetry. Science Direct march 2015;3:17-21.  Back to cited text no. 8
    
9.
Sevim Y, Kocaay AF, Eker T, Celasin H, Karabork A, Erden E, et al. Breast hamartoma: A clinicopathologic analysis of 27 cases and a literature review. Clinics (Sao Paulo) 2014;69:515-23.  Back to cited text no. 9
    
10.
Sonmez FC, Gucin Z, Yildiz P, Tosuner Z. Hamartoma of the breast in two patients: A case report. Oncol Lett 2013;6:442-4.  Back to cited text no. 10
    
11.
Vergine M, Scipioni P, Santucci E, Colangelo M, Livadoti G, De Meo D, et al. Hamartoma of the breast in a young woman. Case report. G Chir 2013;34:161-3.  Back to cited text no. 11
    
12.
Vial MC, Maiz C. Concomitant phyllodes tumor and hamartoma of breast. Int J Radiol Radiat Ther 2017;3:241-3.  Back to cited text no. 12
    




 

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