Haemangioma of the breast: The added value of contrast enhanced ultra-sound (CEUS) in the vascularity assessment of a rare mesenchymal lesion

Haemangiomas have been described in many anatomic locations, but occur quite rarely in the breast; although unfrequent, they are the most common benign vascular tumors of the breast. They are comprised in the cathegory of mesenchymal lesions, a spectrum of lesions that arise in the stroma of the breast as defined by WHO. Here we present the case of a breast haemangioma in a 40-years-old woman, with history of a palpable lump in the left breast slowly increasing in size over time. The lesion first underwent diagnostic biopsy in 2018; after a 5-years follow-up with conventional ultrasound, it was studied in 2023 by our group using Contrast Enhanced Ultra-Sound (CEUS) in order to evaluate its vascularization. Basing on our experience, we conclude that in carefully selected cases of histologically proven breast haemangioma, a conservative management with follow-up imaging is safe; CEUS represents a noninvasive method for studying haemangiomas, superior than traditional US thanks to its ability to provide information about vascularity. In those cases with atypical imaging or clinical pathological suspicious characteristics, a complete surgical resection of the vascular tumor is mandatory–in order to exclude the possibility of an underlying angiosarcoma, especially when the lesion measures more than 2 cm.