Pseudoangiomatous Stromal Hyperplasia of the Breast in a Female Adolescent Presenting as Bilateral Gigantomastia

Abstract

Pseudoangiomatous stromal hyperplasia (PASH) is a rare idiopathic proliferative mesenchymal breast disease related to hormonal imbalance, and thus extremely rare in children and adolescents. In addition, PASH manifests as a bilateral gigantomastia in some cases with no established cause or treatment. Here, we report a case of a rapidly developed PASH presenting with bilateral gigantomastia in a 14-year-old premenarchial female patient. Considering the patient’s age and emotions and the need for nipple-areolar complex repositioning, we performed reduction mammoplasty rather than total mastectomy despite the possibility of recurrence. Although some masses could not be completely removed, no complications, such as infection, wound dehiscence, or hematoma occurred postoperatively. The patient was stable during the 18-month follow-up period, although an evidence of recurrent and residual disease was noted upon ultrasonography.

A case report and a literature review of double mammary pseudoangiomatous stromal hyperplasia associated with galactoma during pregnancy

“…The lesions usually surround the breast lobules, widen the space between the lobules, or extend into the lobules but do not destroy the normal structure of the lobules ( 2 , 14 ). PASH may be mistaken for low-grade angiosarcoma, which has a true vascular space, on pathological examination ( 12 , 15 ). Fascicular PASH has more abundant cells, and the fusiform cells in the lesion are arranged in bundles and lack a fissure structure, which is often observed in conjunction with myofibroblastoma ( 12 , 15 ).…”

“…PASH may be mistaken for low-grade angiosarcoma, which has a true vascular space, on pathological examination ( 12 , 15 ). Fascicular PASH has more abundant cells, and the fusiform cells in the lesion are arranged in bundles and lack a fissure structure, which is often observed in conjunction with myofibroblastoma ( 12 , 15 ). In our case, the areas of interlobular and netted interlobular mesenchyme in both breasts were replaced by typical PASH, the lobular units were enlarged or irregular, but no lobular structure was destroyed, and the ductal epithelium was accompanied by exuberant hyperplasia.…”