A Case of a Giant Pseudoangiomatous Stromal Hyperplasia of the Breast: Magnetic Resonance Imaging Findings

Abstract

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign myofibroblastic process. We present the case of a 17-year-old girl who underwent diagnostic work-up due to an enlargement of her left breast. She was submitted to ultrasounds and magnetic resonance imaging (MRI) which depicted a 14 cm lesion in her left breast. The patient was later operated and histology revealed PASH. Although PASH may range from 0.6–12 cm, a few lesions over 12 cm have been described, the largest being 20 cm. Large series present mammographic and ultrasonographic features of PASH in the literature, but little has been reported on the MR characteristics of PASH up to today. Signal on the T1-weighted image (T1WI) and T2-weighted image (T2WI) may vary. Curves generated from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies are mainly type I or less frequently type II. There are no reports about diffusion-weighted imaging and corresponding apparent diffusion coefficient (ADC) values for PASH in the literature. ADC values in our case lie within the range of values reported for other benign breast lesions. The presence of slit-like spaces within the lesion on MR imaging along with DCE-MRI type I curve and ADC values consistent with a benign lesion may favour the diagnosis of PASH. Tissue biopsy is necessary, however for the final diagnosis. This case report will further contribute to the understanding of MR imaging features of PASH, especially in cases where mammography is not indicated.

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast

“…Our case presents clinically as a bilateral multiple palpable breasts masses with the clinical and radiological assessment coping bilateral multiple fibroadenoma and also MRI findings cope with multiple bilateral lesions with benign criteria however the histo-pathological findings cope with PASH. Yoo cm, but it can also present as an asymmetric appearance of the gland whose size or density increases over time [1]. On our ultrasound they showed bilateral diffuse enlarged breasts with multiple variable sized hypo echoic masses seen scattered inside and this agree with Hargaden et al [5] that say ,PASH has no characteristic appearance, including both its margins and echogenicity.…”

“…The examination protocol consisted of T1-weighted image (T1WI) (Figure 3), T2-weighted image (T2WI) (Figure 4), short-tau inversion recovery (STIR) and Diffusion weighted imaging were also obtained ( Figure 5), as well as dynamic et al [4] had reported that clinical and radiological findings of PASH resemble those of fibrodenoma and all imaging modalities have no specific features to characterize PASH and distinguish it from other pathologic entities. In asymptomatic patients it usually presents as a breast imaging-reporting and data system (BI-RADS) type 3 lesion, suggesting a probably benign lesion [1]. In our case mammography revealed bilateral enlarged dense breasts with bilateral multiple variable sized masses noted and this agree with Solomou et al [1] stated that say mammography of PASH can reveals single or multiple non-calcified masses, with well circumscribed margins, usually ranging from 1-10 contrast-enhanced magnetic resonance imaging (DCE-MRI) after the administration of gadolinium ( Figure 6).…”

“…In asymptomatic patients it usually presents as a breast imaging-reporting and data system (BI-RADS) type 3 lesion, suggesting a probably benign lesion [1]. In our case mammography revealed bilateral enlarged dense breasts with bilateral multiple variable sized masses noted and this agree with Solomou et al [1] stated that say mammography of PASH can reveals single or multiple non-calcified masses, with well circumscribed margins, usually ranging from 1-10 contrast-enhanced magnetic resonance imaging (DCE-MRI) after the administration of gadolinium ( Figure 6). MRI show bilateral enlarged breasts with bilateral multiple variable sized rounded masses are seen scattered inside showing type I kinetic time intensity curve ( Figure 7).…”

“…The age of the diagnosis varies between 14 to 74 years. The size of PASH usually ranges between 0.6-12 cm with most cases ranging from small to medium size [1]. The etiologic factors of PASH are unknown, but most investigators think that it represents a proliferative response of myofibroblasts, probably to hormonal stimuli [2].…”

Rapidly-growing pseudoangiomatous stroma hyperplasia (PASH) causing bilateral gigantomastia in a 15-year-old patient

“…In contrast with mammography and ultrasound, little has been reported on MRI characteristics. No common features have been described and the signal on both T1-and T2weighted images may vary [12]. A MRI is conducted in our patient to assess the lesions and determine their locations.…”