Diagnostic Pitfalls and Imaging–Pathologic Correlation in Benign Breast Vascular Lesions Mimicking Malignancy: A Case-Based Systematic Review

ObjectiveThis article systematically reviews the clinical, imaging, and pathological features of benign breast vascular tumors that mimic malignant neoplasms and summarizes key differential diagnosis points to enhance diagnostic accuracy and avoid misdiagnosis and unnecessary interventions.MethodsAs of December 2025, a literature search was conducted in the PubMed, Web of Science, and Embase databases using keywords "breast hemangioma," "breast lymphangioma," "breast vascular tumor," "benign vascular lesion breast," "angiosarcoma mimic," and "malignant tumor." The inclusion criteria were limited to literature reporting cases of benign vascular tumors confirmed by pathology but initially suspected to be malignant. Ultimately, a total of 10 eligible articles were included for a systematic review.ResultsBenign breast vascular tumors infrequently mimic malignancy: clinically presenting as skin redness, swelling, edema, and pain resembling inflammatory breast carcinoma; demonstrating malignant imaging signs (irregular/spiculated margins, rapid enhancement, washout curve) on mammography, ultrasound, and MRI that elevate BI-RADS classification; and showing atypical cells on cytology prone to misinterpretation. Definitive diagnosis requires multimodal imaging, pathology, and immunohistochemistry.ConclusionBreast vascular tumors are occasionally misdiagnosed as a malignant tumor. It is essential to maintain a high index of suspicion for differential diagnosis during the diagnostic process. For suspected cases, prompt biopsy and rigorous imaging-pathological correlation analysis should be performed. If the biopsy results are inconclusive or show a significant discrepancy with imaging findings, surgical excision should be considered for definitive diagnosis. Most patients have a good prognosis, and all patients remained recurrence-free during follow-up.