Background: Hemangioma of the breast is a rare benign variety of vascular tumours. They are usually small and most patients are asymptomatic. It is either diagnosed accidentally for different purposes (red herring) or at autopsies. Globally, there are scanty publications in the literature about this rare entity since the first publication in 1936. 

Case: Our report focuses on the exceptional occurrence of this case, specifically in a male child who was just 9 years of age which is below the minimum age of occurrence in this gender reported in the literature. Ultrasound examination with Doppler interrogation reveals vague reports with a suspicion of malignancy. Mammography could not be performed because the dense mass would be obscured by the normal soft tissue density of the breast for the patient’s age. An extensive and complete surgical excision was performed due to the equivocal ultrasound findings. The insidious growth in tumour size and inclusive findings on aspiration cytology required open surgery with histology.

Conclusion: We present a case of the largest known breast benign hemangioma in a 9-year-old boy with equivocal ultrasound findings.  The value of imaging in identifying the differential diagnosis of hemangioma cannot be overemphasised. However, the mainstay of diagnosis remains a histological biopsy, which revealed a benign breast hemangioma.

Keywords: hemangioma, breast cancer, rare vascular tumour, male breast