Capillary hemangioma of the breast presenting as a new mass on screening mammography: A case report with imaging-pathology correlation

Capillary hemangioma of the breast is a rare benign vascular lesion that may be detected as a new mass at screening mammography. We report a 74-year-old asymptomatic woman with a newly developed 0.7-cm mass in the posterior left breast. Diagnostic mammography showed an oval, equal-density mass with partially obscured margins, and targeted ultrasound demonstrated a 0.6-cm oval, circumscribed, hypoechoic superficial mass with posterior acoustic enhancement and limited internal Doppler flow associated with a feeding vessel. Because the finding was new and indeterminate, it was assessed as BI-RADS 4A and sampled by ultrasound-guided core needle biopsy. Histologic examination showed a well-circumscribed proliferation of capillary-sized, erythrocyte-containing vessels lined by a single layer of bland, flattened endothelial cells, without cytologic atypia or mitotic activity. D2-40 highlighted background lymphatic vessels but was negative in the lesional channels. No histologic features of angiosarcoma were identified in the sampled tissue. Imaging and pathology were concordant; no surgical excision was performed, and the patient returned to routine annual screening. This case illustrates that interval development may justify biopsy despite relatively benign morphology and that a small capillary hemangioma with benign concordant pathology in an asymptomatic older patient may be managed conservatively while recognizing the sampling limitations of core biopsy.