Rapidly growing nodular pseudoangiomatous stromal hyperplasia of the breast in an 18‐year‐old girl

Abstract

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare benign proliferation of mesenchymal stromal cells with irregular slit-like formations resembling angiomatous structures. In the majority of cases this lesion is a focal microscopic finding in breast biopsies performed for benign or malignant diseases. It may present in a pure diffuse or nodular form. The exact etiology and pathogenesis of this tumor-like lesion is still unknown, but a proliferative response of myofibroblasts to hormonal stimuli has been postulated. A large 12 x 9 x 3.5 cm rapidly growing nodular form of PASH of the breast in an 18-year-old woman is here described with clinical and histological findings. A possible hormonal etiology was indicated by elevated progesterone (three-fold) and decreased estrogen serum levels. Different diagnostic lesions, such as giant fibroadenoma and low-grade angiosarcoma, are discussed. To the authors' knowledge this is only the fourth case of nodular PASH of the breast reported in the English literature.

Myoid (Muscular) Hamartoma of the Breast: Case Report and Review of the Literature

“…It is the presence of CD34 in smooth muscle cells that some authors consider a crucial sign of stromal cell metaplasia into smooth muscle cells [2,5]. Although we did not prove CD34 expression in the foci of smooth muscle cells, expression of this antigen was detected in the loci of the pseudoangiomatous stromal hyperplasia within the MH, as described previously [23], thus confirming its hormonal origin [24]. Supplementary evidence supporting this hypothesis of metaplasia, hormonal aetiopathogenesis, and sensitivity, is the presence of hormonal receptors in smooth muscle cells.…”

Rapidly Enlarging Tumoral Pseudoangiomatous Stromal Hyperplasia in a 15-Year-Old Patient

“…Only 4 cases of tumoral PASH of the breast have been reported in the English literature. 9 The lesion in our case, …”

“…Pseudoangiomatous stromal hyperplasia presents mainly in premenopausal women and is rarely seen in adolescence. [8][9][10] To our knowledge, our patient, 15 years old, is the youngest reported to date. Pseudoangiomatous stromal hyperplasia is a proliferation process thought to be secondary to a progesterone effect.…”

Pseudoangiomatous Stromal Hyperplasia and Breast Cancer Risk

“…First described by Vuitch et al in 1986[1], PASH is a relatively rare clinical problem. Since its original description, most information on PASH has consisted primarily of case reports [2-5] with a few moderate size case series more recently [6-8]. There are two primary clinical presentations- either distinct nodular growth or diffuse enlargement of the breast.…”