Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases

Abstract

Pseudoangiomatous stromal hyperplasia tumors are rare. In this retrospective study, we evaluated the clinical, radiologic, and pathologic features of pseudoangiomatous stromal hyperplasia tumors and compared histologic findings of pseudoangiomatous stromal hyperplasia tumors with clinical outcome. We identified 26 patients (mean age, 47 years) with pseudoangiomatous stromal hyperplasia tumors who had been diagnosed at our institution. Sixteen patients (62%) were premenopausal, and 13 (50%) had a history of oral contraceptive or hormone replacement therapy use. Ten patients (38%) presented with a palpable mass; in the other patients, the tumors were detected by mammography (where it usually appeared as a hyperdense mass with irregular margins) or sonography (where it usually appeared as a hypoechoic mass). Lesions were a mean of 4.2 cm at the largest dimension (range, 0.8-11 cm). Histologically, pseudoangiomatous stromal hyperplasia was classified as simple in 18 patients (69%) and fascicular/proliferative in eight patients (31%). In one patient (4%), an invasive ductal carcinoma was present within the pseudoangiomatous stromal hyperplasia tumor. We found associated benign epithelial lesions in eight patients (31%) and/or gynecomastia-like changes in 17 patients (65%). The presence of gynecomastia-like changes was significantly associated with intralobular location of pseudoangiomatous stromal hyperplasia (P ¼ 0.00085, by Fisher's exact test). Follow-up data were available for 15 patients (mean±s.d., r27±17 months). No additional pathology or substantial changes in existing lesions were found on imaging. All pseudoangiomatous stromal hyperplasia tumors diagnosed by core needle biopsy but not subsequently excised remained clinically and radiologically stable; therefore, offering the option of close clinical surveillance instead of surgery in patients with pseudoangiomatous stromal hyperplasia tumors diagnosed by core needle biopsy in selected patients.

Bilateral Diffuse Pseudoangiomatous Stromal Hyperplasia (PASH) Causing Gigantomastia in a 33-Year-Old Pregnant Woman: Case Report

“…However, the very rare diffuse PASH with massive breast enlargement requires uni-or bilateral mastectomy as in our patient and other reported cases [3][4][5]. The risk of recurrence after surgical excision is up to 22% [6,12]. There is no established conservative therapy for PASH, although a single case of successful treatment with tamoxifen has been reported by Pruthi and colleagues [13].…”

Tumour forming Pseudoangiomatous stromal hyperplasia: a case report

“…The recurrence rates of PASH after the excision ranges from 15 to 22%. 1,5,7 Overall, the prognosis for PASH is excellent. Pseudoangiomatous stromal hyperplasia is not considered a premalignant lesion or a risk factor for malignancy.…”

“…4 The tumoral form of PASH most commonly manifests as a single, circumscribed, palpable mass in a premenopausal female. 5 The mass is usually large which may vary from 2-12 cm. The presenting age ranges from 14-65 years.…”

“…The spaces are lined by benign spindle cells, which show myofibroblastic differentiation and express progesterone receptors. 4,5 It can be confused with vascular tumors such as low grade angiosarcoma and cystosarcoma phyllodes, and may require immunohistochemistry studies when in doubt. Local surgical excision with adequate margins is the recommended treatment for tumorous PASH.…”

Pseudoangiomatous Stromal Hyperplasia: Diagnosis, Treatment and Follow-Up; Description of a Case-Series

“…Our data also supports a policy in which excision is only offered to selected patients. Further indications for surgery may be mechanical complaints, pain or apprehension for an alternative (malignant) diagnosis [3,[11][12][13]. Follow-up is also not advised although regular screening is necessary for the life-time risk of breast cancer.…”