39 year old female with breast biopsy

This is the case of a 39 yo female who was found to have a microcalcifications in the breast. She underwent a core biopsy.

This case was generally one of these cases where the pathology is picked just because the normal tissues did not look normal and not because I knew the pathology itself.  At first I did not know what to make out of the finding but gradually I have figured it out.

The biopsy itself was benign with fibroadenoma and no calcifications, however there were some additional findings which I could not explain nor I can ignore.

View the slides here: Case.

As yo see the thickness of these intermediate size arteries was way to big to be ignored. To be honest I was thinking at the beginning about  "age related changes" when I realized that the woman is actually too young to have these changes.

The second question I had in mind was could she have hypertension and diabetes and these changes to represent a vascular damage.  So I just called the surgeon who did the biopsy to give him the preliminary diagnosis and to ask for clinical history. The patient was no diabetic or hypertensive ( thinking about fibromuscular dysplasia) instead he told me that the patient had a Neurofibromatosis type 1 ( von Recklinghausen ). After 2 days browsing the PubMed I came to the conclusion that the changes are actually due to Neurofibromatosis, so called vasculopaty of von Recklinghausen disease.

The Vascular Lesions of Neurofibromatosis
William R. Salyer
Angiology, Vol. 25, No. 8, 510-519 (1974) [Link]

"Peculiar arterial lesions were found in seven of 18 cases of neurofi bromatosis. As previously described, these were of four types: pure intimal, advanced intimal, intimal aneurysmal, and nodular. Many lesions had features of more than one of the pure types."

 Are the changes significant:

The answer is YES since patients with such changes may present with Suddend death (cororany vessels) or bleeding (head, pleural space or GI) due to aneurisms formation.