A case of nodular pseudoangiomatous stromal hyperplasia (PASH)

Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Breast Cancer (Impact Factor: 1.59). 02/2006; 13(4):349-53. DOI: 10.2325/jbcs.13.349
Source: PubMed


Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a common microscopic lesion that is found at breast biopsy, and presents with proliferation of the stromal cells and slit-like pseudovascular spaces with endothelial-like spindle cells. In contrast, nodular PASH is relatively rare. We report here a case of nodular PASH with multiple palpable masses. A 49-year-old woman who had experienced gradual enlargement of her breasts for 13 years noticed an elastic but firm palpable mass in her breast. We were able to detect 7 masses in her right breast and 2 in the left. Ultrasonography and mammography demonstrated nonspecific findings, and FNA and CNB did not establish a diagnosis. An excisional biopsy was performed, and the pathological findings revealed nodular PASH. Eighteen months after the excisional biopsy, the size of the nodules and the whole breast had decreased remarkably. While the possibility of a change in the hormonal background or the influence of drugs was considered, we were not able to reach a single specific conclusion regarding the pathogenesis.

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    • "Pseudoangiomatous stromal hyperplasia (PASH) is an unusual benign breast condition that was first described in 1986 [1]. The reported age range of patients is 14-67 years, although the vast majority of PASH patients present in their late thirties and forties [2]. It is histologically defined as a complex network of slit-like spaces lined by endothelial-like spindle cells against a background of stromal hyperplasia [3]. "
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    ABSTRACT: Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign lesion, characterized by a dense proliferation of stromal mesenchymal cells of myofibroblastic origin forming empty, slit-like channels. We report PASH in a 12-year-old girl with a huge rapidly enlarged right breast. Biopsy of the mass showed histopathologic features characteristic of PASH. Immunohistochemical studies revealed diffuse positive membranous immunoreactivity to CD34. Although it is a benign lesion, lumpectomy was performed to minimize the damage from developing breast tissue.

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    ABSTRACT: Spindle cell lesions of the breast represent an interesting diagnostic problem, as the differential diagnoses are wide. Diagnosing this is particularly problematic but important when encountered in a needle core biopsy, as treatments of different entities are different. In the histologic assessment of spindle cell lesions, the simplified approach is to evaluate the spindle cells and the accompanying epithelial cells. In the biphasic lesions with predominance of spindle cells with benign epithelial component, fibroepithelial lesions including fibroadenomas and phyllodes tumors are the most common, followed by pseudoangiomatous stromal hyperplasia, hamartoma and adenomyoepithelioma. For biphasic lesions with predominance of spindle cells with malignant epithelial component, the biphasic metaplastic carcinoma is likely. For monophasic lesions with pure pleomorphic spindle cell only, the monophasic metaplastic carcinoma is more common than the rare primary sarcomas like malignant fibrous histiocytoma, angiosarcoma, and other high grade sarcomas. In monophasic lesions with pure bland spindle cells only, the possible lesions include fibromatosis, fibromatosis like metaplastic carcinoma and other unusual conditions like dermatofibrosarcoma protuberance. By careful searching for the accompanying epithelial element, and with the aid of appropriate clinical input and judicious use of immunohistochemistry, many of these lesions can be confidently diagnosed in the needle core biopsy, thus facilitating appropriate treatments.
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