Bilateral Simultaneous Pseudoangiomatous Stromal Hyperplasia of the Breasts and Axillae: Imaging Findings with Pathological and Clinical Correlation

Abstract

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a pathology that is usually diagnosed by accident during pathological examination of other breast lesions. PASH is an uncommon and benign tumoral lesion of the mammary stroma that can be pathologically mistaken for other tumours, such as phyllodes, fibroadenoma, and sometimes even angiosarcoma. We report the case of a 45-year-old woman with complaints of huge bilateral breast enlargement. This is a rare case of PASH presenting with gigantomastia and involving bilateral breasts and axillae simultaneously. Mammography, ultrasonography, and MRI features are illustrated with histopathological correlation.

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

“…Bilateral diffuse multiple tumors leading to massive bilateral breast enlargement are rare. Other reports have been published presenting patients with bilateral gigantomastia due to PASH [5][6][7][8][9], all reporting bilateral breast enlargement, with palpable masses in some cases. However, Fig.…”

“…Until today, no recurrence has been observed during follow-up. In the other cases presenting patients with bilateral gigantomastia due to PASH, mastectomies were performed, except for two where in one patient a breast reduction was performed and in the other one the lesions were observed [5][6][7][8][9]. No recurrence was reported.…”

Bilateral diffuse tumorous pseudoangiomatous stromal hyperplasia treated with bilateral mastectomy in a 40-year-old woman

“…PASH has overlapping imaging features with fibroadenomas, harmartomas, and angiosarcomas, and larger lesions can be mistaken for phyllodes [14] . The coexistence of fibrocystic changes results in a heterogenous appearance, and a less commonly reported sonographic feature is a heterogeneous region with hypoechoic central areas [15] . In the present case, fibrocystic changes coexisted with PASH, and FCD was diagnosed at the initial core needle biopsy.…”

“…These features may have led to a heterogenous echotexture of the bilateral masses in the present case. Internal cystic changes, which are a characteristic feature of PASH, can be detected by US [15] .…”

An Uncommon Case of Bilateral Breast Enlargement Diagnosed as Tumoral Pseudoangiomatous Stromal Hyperplasia: Imaging and Pathological Findings

“…Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon nonneoplastic proliferation of the myofibroblastic cells in the mammary stroma [ 1 , 2 ]. Clinically, PASH is frequently presented as a unilateral or bilateral focal microscopic changes.…”