Pseudoangiomatous Stromal Hyperplasia of the Breast in Pediatric Patients: An Underrecognized Entity

Shehata, Bahig M.; Fishman, Inessa; Collings, Margaret H.; Wang, Jenny; Poulik, Janet; Ricketts, Richard R.; Parker, Paul; Heiss, Kurt F.; Bhatia, Amina; Worcester, Heath D.; Gow, Kenneth W.

doi:10.2350/08-09-0528.1

Cited by 50 publications

(35 citation statements)

References 13 publications

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“…On mammography there were varied histological features, although none suggested malignancy. Ultrasound likewise revealed most masses to be homogeneous and oval or round (10) and heterogeneous oval or round (5) with well circumscribed margins. There were 8 patients with follow‐up images ranging from 6 to 60 months that were found to have stable masses and 10 patients had no follow‐up.…”

Section: Resultsmentioning

confidence: 99%

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: A Series of 24 Patients

Bowman¹,

Oprea²,

Okoli³

et al. 2012

The Breast Journal

108

109

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Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. In 2005, only 109 cases had been reported since its initial description in 1986 by Vuitch et al. Our 24 cases represent one of the largest series to be reported from a single institution. We retrospectively reviewed data from 2004 to 2010 of patients diagnosed with PASH by surgical excision or image-guided biopsy. All pathological specimens were reviewed by a single pathologist. The samples were stained for estrogen and progesterone receptors (ER and PR), CD34, and the lymphatic marker D2-40. All but one of 24 (96%) patients presented with breast masses either on imaging or clinically. Fourteen of the 24 patients (58%) were diagnosed on surgical excision, 10 (42%) diagnosed with core needle biopsy, and five (20%) were diagnosed using both techniques. The tumors ranged in size from 0.3 cm to 7.0 cm. All women except two were premenopausal or perimenopausal at diagnosis. Nineteen samples were available for hormonal receptor staining and of these 18 of 19 (95%) were ER or PR positive. PASH was diagnosed in two men, a transgender male on hormones and the other with gynecomastia. The patients’ ages ranged from 18 to 86 years old. In addition to PASH other benign histopathological findings include stromal fibrosis and atypical ductal or lobular hyperplasia. Imaging revealed no distinguishing feature for PASH with benign histology. One patient had synchronous ductal carcinoma in-situ (DCIS). Patients were treated with local excision or observation. This study suggests that PASH is primarily a diagnosis of premenopausal and perimenopausal women. Our series supports a hormonal basis for its development due to the positive staining for hormonal receptors. Management is conservative surgery for larger masses with careful observation being an option in patients not at high risk for breast cancer.

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Section: Resultsmentioning

confidence: 99%

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: A Series of 24 Patients

Bowman¹,

Oprea²,

Okoli³

et al. 2012

The Breast Journal

108

109

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“…PASH commonly occurs in premenopausal women (mean age, 37 years) (Powell et al 1995). However, it is also often observed in postmenopausal women undergoing hormone replacement therapy, infants (Shehata et al 2009), and men. Particularly, in men with gynecomastia, it reportedly exists in 98% of PASH cases (Badve and Sloane 1995).…”

Section: Discussionmentioning

confidence: 99%

Large pseudoangiomatous stromal hyperplasia complicated with gynecomastia and lobular differentiation in a male breast

Mizutou¹,

Nakashima²,

Moriya³

2015

SpringerPlus

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Pseudoangiomatous stromal hyperplasia (PASH) is a benign lesion often observed in parts of the mammary stroma in a variety of breast diseases. It is characterized by stromal myofibroblastic proliferation that possesses irregularly anastomosing slit-like pseudovascular spaces lined by a layer of spindle cells. PASH commonly occurs in premenopausal women; however, it has also been observed in men with gynecomastia. Although tumor-forming lesions are rare, we report on a case with a large PASH in a male breast complicated with gynecomastia. Imaging showed a tumor with a diameter of >10 cm in the left breast, and aspiration cytology revealed a benign lesion. Since the tumor was large and gradually increased in size, a simple mastectomy was performed. The tumorous lesion was diagnosed as PASH based on the pathological and immunohistological findings. It was complicated by gynecomastia with acinar and lobular formation, which resembled female mammary gland secretory activity that is observed during lactation.

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“…A dominant role of progesterone could also explain the rapid breast enlargement in our patient during first trimester of the pregnancy. However, there are also rare reports of PASH in children or postmenopausal women with no exogenous hormonal influence [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Bilateral diffuse pseudoangiomatous stromal hyperplasia (PASH) causing gigantomastia in a 33-year-old pregnant woman: case report

Krawczyk¹,

Fehm²,

Mohrmann³

et al. 2015

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Pseudoangiomatous Stromal Hyperplasia of the Breast in Pediatric Patients: An Underrecognized Entity

Cited by 50 publications

References 13 publications

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: A Series of 24 Patients

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: A Series of 24 Patients

Large pseudoangiomatous stromal hyperplasia complicated with gynecomastia and lobular differentiation in a male breast

Bilateral diffuse pseudoangiomatous stromal hyperplasia (PASH) causing gigantomastia in a 33-year-old pregnant woman: case report

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