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.
Racial residential segregation may influence health for blacks and whites differently. Pathways through which RRS patterns impact health should be further explored.
All TRAM LRR were detected by routine physical examination by the patient or the surgeon. Our findings suggest that routine history and clinical breast examination of the breast reconstructed with a TRAM flap along with patient self-awareness are reliable in the diagnosis of LRR.
Exhaled breath contains more than 1000 constituents at trace level concentrations, with a wide variety of these compounds potentially serving as biomarkers for specific diseases, physiologic status, or therapeutic progress. Some of the compounds in exhaled breath (EB) are well studied, and their relationship with disease pathologies is well established. However, molecularly specific analysis of such biomarkers in EB at clinically relevant levels remains an analytical and practical challenge due to the low levels of such biomarkers frequently below the ppb (v/v) range in EB. In this contribution, mid-infrared (MIR) spectroscopic sensing techniques are reviewed for potential application in breath diagnostics. While the spectral regime from 3-20 m has already been utilized for fundamental studies on breath analysis, significant further improvements are in demand for substantiating MIR spectroscopy and sensing techniques as a suitable candidate for clinically deployable breath analyzers. Several advantageous features including inherent molecular selectivity, real-time monitoring capability, comparable ease of operation, potentially low costs, and a compact device footprint promise reliable optical diagnostics in the MIR. Hence, while the application of MIR spectroscopy and sensing systems to breath analysis yet appear in their infancy, recent progress on advanced MIR light sources, waveguides, and device concepts forecasts next-generation optical sensing platforms suitable for addressing the challenges of in situ breath diagnostics.
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