Angioblastoma of Breast Complicating Pregnancy

Since 1920 about one case of mammary haemangioma a year has been reported, in approximately equal numbers of cavernous and capillary types, and with evidence of malignancy in eight of these. Menville and Bloodgood (1933) describe eight examples, only one of which was malignant, in 3,000 consecutive breast neoplasms examined histologically. As probably all angiomata, but not all carcinomata, would be examined, this may well be too high a proportion. This is the only case treated at Charing Cross Hospital over a period in which about 1,000 breast tumours were seen. This suggests a general incidence of not more than 0.1 % of all mammary neoplasms, while the incidence of malignant haemangioma may possibly be as low as 0.03 °,'-truly a rare condition. No recorded case, however, appears to have been associated with pregnancy, nor has the tumour reached such an enormous size as this one; and the malignant cases were generally of much lower grade. These three factors may possibly be interrelated, and, I think, make this case worth recording. The high degree of clinical malignancy, shown by the rapid recurrence and fatal outcome within nine months, was not predictable on histological grounds. Microscopically there was actually very little tumour tissue to be seen, which explains the earlier biopsy being quite negative even after re-examination in the light of subsequent findings. Menville and Bloodgood, in their review, point out that there is often enough clinical evidence for the diagnosis to be considered pre-operatively. Although this tumour was clinically atypical, the extremely rapid increase in size in April, due presumably to an interstitial haemorrhage, was suggestive. It has long been recognized that pregnancy may be associated with a particularly virulent form of carcinoma of the breast, but here we have an example of the mesoblastic tissues undergoing a malignant change under the influence of pregnancy. There was probably a pre-existing simple angioma which was stimulated into activity by hormonic influences similar to those which possibly produce carcinomata. It seems less probable that the process is a two-step one, the epithelial tissues, themselves stimulated by circulating hormone, causing a local stimulation of the surrounding mesoblastic tissues; for then one would expect mammary angioma to be much commoner than the above figures suggest.