Capillary Hemangioma of the Breast Parenchyma Mimicking New Primary Cancer or Metastasis During Ramucirumab Therapy for Advanced Gastric Cancer

Sep 28, 2026

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Ramucirumab, an anti-VEGFR-2 monoclonal antibody, improves survival in advanced gastric cancer but commonly causes hypertension, proteinuria, and hemorrhage via anti-angiogenic effects. Despite VEGF pathway involvement in hemangiomas, development of new hemangiomas during VEGFR-2 inhibition is rarely reported. A 38-year-old woman with stage IV gastric adenocarcinoma developed a newly enhancing hypervascular breast nodule during ramucirumab and paclitaxel therapy, initially suspected as metastasis or primary cancer. Biopsy confirmed capillary hemangioma. Subsequent imaging showed spontaneous regression and disappearance.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Introduction

Case Report

Conclusion

doi: 10.21873/invivo.14219 Capillary Hemangioma of the Breast Parenchyma Mimicking New Primary Cancer or Metastasis During Ramucirumab Therapy for Advanced Gastric Cancer HONG-BEUM KIM1*, YEON-AH LEE2*, SEONG-HUN KIM3 and SANG-GON PARK3 1 Department of Premedical Course, Chosun University School of Medicine, Gwangju, Republic of Korea; 2 BlessU Woman Surgery Clinic, Gwangju, Republic of Korea; 3 Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju, Republic of Korea Abstract Background/Aim: Ramucirumab, a monoclonal antibody targeting vascular endothelial growth factor receptor-2 (VEGFR-2), has been shown to prolong survival inpatients with advanced gastric cancer when combined with paclitaxel as second-line chemotherapy in the RAINBOW study. The most common adverse events include hypertension, proteinuria, and hemorrhage, reflecting its anti-angiogenic activity. Although the VEGF signaling pathway is strongly implicated in the pathogenesis of hemangiomas, the development of new hemangiomas during VEGFR-2 inhibition is rarely reported. Case Report: A 38-year-old woman with stage IV gastric adenocarcinoma presented with peritoneal dissemination and lymph node metastasis. She initially received FOLFOX plus immune checkpoint inhibitor therapy, achieving a partial response before disease progression. Second-line treatment with paclitaxel and ramucirumab was initiated. During therapy, chest computed tomography revealed a newly developed contrast-enhancing nodule in the left breast parenchyma, raising suspicion of metastasis or primary breast carcinoma. Breast ultrasonography confirmed ahypervascular lesion, and ultrasound-guided biopsy demonstrated numerous capillary-sized vessels lined by bland endothelial cells, consistent with capillary hemangioma. Owing to deterioration of her general condition, chemotherapy was temporarily discontinued. Despite subsequent third-line FOLFIRI and fourth-line trifluridine/tipiracil treatment, the patient eventually died of disease progression. Notably, follow-up chest CT scans showed gradual reduction and eventual spontaneous disappearance of the breast hemangioma, independent of systemic therapy. Conclusion: This isarare case of abreast parenchymal capillary hemangioma arising during ramucirumab therapy for advanced gastric cancer, which regressed spontaneously. Clinicians should recognize that atypical vascular lesions may develop paradoxically during VEGFR-2 blockade and confirm histological diagnosis to avoid misinterpretation as metastasis or new primary malignancy. Keywords: Capillary hemangioma, breast parenchyma, ramucirumab, VEGFR-2 inhibition, hypervascular lesion. *These Authors contributed equally to this study. ✉ Sang-Gon Park, MD, PhD, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. Tel: +82 622203984, Fax: +82 622349653, e-mail: [sgpark@chosun.ac.kr](sgpark@chosun.ac.kr) Received September 12, 2025 | Revised October 10, 2025 | Accepted October 13, 2025 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. ©2026 The Author(s) . Anticancer Research is published by the International Institute of Anticancer Research. Introduction Ramucirumab is a fully human monoclonal antibody directed against vascular endothelial growth factor receptor-2 (VEGFR-2), thereby suppressing angiogenesis. Results from the pivotal RAINBOW trial demonstrated that the addition of ramucirumab topaclitaxel as a second-line regimen significantly improved overall survival in patients with advanced gastric cancer, leading to its incorporation as a standard therapeutic option (1-3). The predominant toxicities observed with ramucirumab include hypertension, proteinuria, and hemorrhagic events, all primarily relate

FAQs

Why was the newly found breast lesion initially concerning in this patient?

Chest CT revealed a new contrast-enhancing nodule in the left breast parenchyma during therapy, leading clinicians to suspect metastasis or a new primary breast carcinoma.

How was capillary hemangioma confirmed rather than cancer?

Breast ultrasonography showed a hypervascular lesion, and ultrasound-guided biopsy demonstrated numerous capillary-sized vessels lined by bland endothelial cells consistent with capillary hemangioma.

What happened to the breast hemangioma after treatment?

Follow-up chest CT showed gradual reduction and eventual spontaneous disappearance of the breast hemangioma, independent of systemic therapy.

Sep 28, 2026

Uploaded by ahduag