dynamic contrast - enhanced magnetic resonance imaging ( dce - mri ) is an important diagnosis tool of breast disease because of its good soft tissue resolution and time - signal intensity curve ; it has a higher sensitivity and often presents malignant breast nodules which are missed by physical examination , mammography and ultrasound ( 1 - 3 ) .
we present an interesting case of an asymptomatic 30-year - old female asian patient with a small suspicious breast nodule which was not detected by breast palpation , mammography , and color doppler ultrasound , but was detected by dce - mri .
this nodule was surgically removed and pathologically confirmed as hemangioma , a kind of benign vascular tumor which is rarely seen in the breast .
we present an asymptomatic 30-year - old female asian patient who gave birth 2 years ago .
ten months ago , the patient underwent breast palpation , mammography , and ultrasound ( for the first time ) .
the results present a nodule ( 1.6  1.2  0.9 cm ) locating on the right breast at 7 o'clock position with an oval shape , clear boundary , internal hypoechoic , and calcifications .
, mr scanning ( ge signa hdxt 3.0 t ) was performed according to the recommendation of a clinician .
dce - mri did not detect enhancement of the mass ( breast fibroadenoma with calcification ) .
surprisingly , a new small nodule ( 0.7  0.5  0.4 cm ) was found at the upper outer quadrant of the right breast .
mri presented an oval mass located on the mammary gland , anterior to the superficial pectoralis fascia with a well - defined margin .
1a ) , while a t2-weighted image showed the mass area of high signal ( fig .
the region of interest was obtained from the enhancing area of the lesion to generate a time - signal intensity curve .
ultrasound was then carefully performed on the patient ( for the second time ) , showing an oval nodule with a well - defined margin and internal hypoechoic ( fig .
two experienced radiologists made a surface marker for the lesion based on the dce - mri and ultrasound presentation . in the operating room ,
the surgeon confirmed the lesion again by ultrasound ( for the third time ) before the surgery .
the lesion was pathologically confirmed as breast capillary hemangioma , which is a benign vascular tumor and rarely seen in the breast ( fig .
immunohistochemical staining showed strong positive cd34 expression and negative ck expression of the lesion , which supported our diagnosis ( fig .
ultrasound is a very useful tool for checking breast diseases , especially in young women with mammary gland hyperplasia . while it has been reported that hemangiomas always show an oval or lobular shape with well circumscribed or microlobulated margins on sonography ( 4 ) ( which were also seen in our case ) , these characteristics are not sufficiently specific .
while hemangiomas often locate in a superficial position ( subdermal or in the subcutaneous tissues ) ( 5 , 6 ) ( which is similar to our case ) , this location makes it difficult to visualize the mass on regular craniocaudal and mediolateral oblique views , tangential views are necessary to prove the superficial nature of the mass .
however , benign hemangiomas in the breast have also been described as displaying high vascularity .
mri and dce - mri are frequently used to check for breast disease in asian women because of the common occurrence of mammary gland hyperplasia and smaller size of female breasts .
it is well known that mri could detect inconspicuous lesions because of its good soft tissue resolution ( 7 ) .
breast hemangiomas have been reported to show homogeneous hyperintensity on t2-weighted images as in our case . in a gd - enhanced dynamic study , vorela al et al . reported that hemangiomas present early intensive enhancement followed by a plateau ( 8) , which differs from our case ( washout type curve , indicating malignant breast lesion ) , and the images and curve render it difficult to confirm the diagnosis .
the difference of vascular morphology and numbers might be the main reason for the different dce - mri presentation and curve type .
angiosarcoma is rare but the most malignant of all breast neoplasm , with a mean survival time of about two years .
this tumor presents as an ill - defined , unencapsulated , soft , spongy mass with dilated vascular channels . hemorrhage and necrosis are common , especially in larger tumors .
histologically , the endothelial cells of angiosarcoma are usually large , plump , and single layered .
hemangiomas are benign vascular tumors of two common types ( capillary or cavernous ) that are based on the size of the vessels involved . in this case
, microscope imaging showed that the hyperplastic vascular tumor has a regular morphology and clear boundary , has no interstitial infiltrates , no vascular branching structure , and the papilla structure could be found in the lumens .
endothelial cell atypia , papillary tufting , mitotic figures , necrosis , or other features of atypical vascular lesion or angiosarcoma were not identified .
it has been reported that breast hemangioma could be found in 11% of postmortem specimens of the female ( 10 ) .
if the dce - mri presents a small mass ( usually  2 cm ) with a clear boundary , homogeneous enhancement , superficial location , and even the mass presents a washout type curve , alerting the radiologists that hemangioma could be a possible diagnosis .
 breast capillary hemangioma is a type of benign vascular tumor which is rarely seen . 
 little is known about its presentation on dynamic contrast - enhanced magnetic resonance imaging ( dce - mri ) . here 
 , we describe a case of suspicious breast lesion detected by dce - mri and pathologically confirmed as capillary hemangioma . 
 our case indicates that a small mass with a superficial location , clear boundary , and homogeneous enhancement on dce - mri indicates the possible diagnosis of hemangioma , whereby even the lesion presents a washout type curve . 
INTRODUCTION
CASE REPORT
DISCUSSION