Article

A case of nodular pseudoangiomatous stromal hyperplasia (PASH).

Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Breast Cancer (Impact Factor: 1.51). 02/2006; 13(4):349-53. DOI: 10.2325/jbcs.13.349
Source: PubMed

ABSTRACT 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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    ABSTRACT: Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign myofibroblastic process. We present the case of a 17-year-old girl who underwent diagnostic work-up due to an enlargement of her left breast. She was submitted to ultrasounds and magnetic resonance imaging (MRI) which depicted a 14 cm lesion in her left breast. The patient was later operated and histology revealed PASH. Although PASH may range from 0.6-12 cm, a few lesions over 12 cm have been described, the largest being 20 cm. Large series present mammographic and ultrasonographic features of PASH in the literature, but little has been reported on the MR characteristics of PASH up to today. Signal on the T1-weighted image (T1WI) and T2-weighted image (T2WI) may vary. Curves generated from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies are mainly type I or less frequently type II. There are no reports about diffusion-weighted imaging and corresponding apparent diffusion coefficient (ADC) values for PASH in the literature. ADC values in our case lie within the range of values reported for other benign breast lesions. The presence of slit-like spaces within the lesion on MR imaging along with DCE-MRI type I curve and ADC values consistent with a benign lesion may favour the diagnosis of PASH. Tissue biopsy is necessary, however for the final diagnosis. This case report will further contribute to the understanding of MR imaging features of PASH, especially in cases where mammography is not indicated.
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    ABSTRACT: Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign breast disease, characterized by interanastomosing slit-like spaces lined with spindle-shaped cells in a collagenous stroma; it is most commonly seen in premenopausal women. This disease is a frequent incidental microscopic finding in breast biopsies. It may be symptomatic and appears then as a palpable lump. The authors report a case of a 19-year-old girl with a palpable nodule in the right breast, which mimicked clinically and radiologically a fibroadenoma. PASH should be distinguished from angiosarcoma in a daily practice. It is ruled out by immunohistochemistry. They discuss in this work the clinical presentation, radiological and pathological features of this unusual condition.
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