How to manage pseudoangiomatous stromal hyperplasia: our clinical experience

Abstract

Background/aim: Pseudoangiomatous stromal hyperplasia (PASH) is a rare and benign mesenchymal proliferative breast lesion. Our aim is to review the clinical and radiological features of PASH and define a standard approach for its diagnosis and management. Materials and methods: Clinical records of 35 consecutive patients with PASH were retrospectively reviewed between 2009 and 2015. Patients with clinically or radiologically detected mass and patients who underwent biopsy for other indications and were diagnosed incidentally were included in the study. Results: There were 34 female patients and one male patient with gynecomastia. Twenty-three patients had palpable masses, and 16 of them were diagnosed as PASH with a median size of 3.1 cm. PASH did not show any specific features in radiological imaging. Core needle biopsy was performed for 3 patients before surgical excision; however, the lesions had not been diagnosed as PASH. In pathological examination, lesions associated with PASH showed nonproliferative changes in 14 patients, proliferative changes without atypia in 17, one phyllodes tumor, one in situ tumor, and one invasive cancer. Conclusion: Imaging findings of PASH are nonspecific. It is difficult to give a true prognostic diagnosis through pathological evaluation of big masses with core needle biopsy. We recommend surgical excision, especially for big lesions with suspicious features.

Pseudoangiomatous stromal hyperplasia of the breast: A case report

“… 9 Kurt et al recommended excision, especially for lesions with suspicious features. 13 In our cases, we surgically removed the lesions in each case.…”

Pseudoangiomatous Stromal Hyperplasia-Case Report of a Rare Breast Tumor in a Premenarchal Girl

“…1,4,10 Highly variable recurrence rates following excision have been reported, ranging from 0% to 29%, largely attributed to incomplete excision or presence of unknown multifocal lesions. 6,11 In our case, surgical excision was performed, with successful clinical and cosmetic results and no recurrence at 3-year follow-up.…”

“…Moreover, it should be considered that even though PASH is a benign neoplasm, malignant tumors may coexist with PASH lesions, therefore the histologic analysis accomplished by core needle biopsy could be insufficient to allow an accurate diagnosis, particularly in cases of mass-forming PASH. 6 Therefore, according to literature, treatment is usually not necessary for incidental and non-suspicious focal lesions. With regard to nodular forms of PASH, wide excision remains the cornerstone of management.…”

“…PASH has a wide spectrum of clinical presentations: often is recognized as a microscopic abnormal pattern identified incidentally; occasionally, a breast lump is perceived in the clinical evaluation and, on rare occasions, it presents with a giant mass causing asymmetry of the breast, referred as nodular or massforming PASH type. 4,6…”

Pseudoangiomatous stromal hyperplasia of thebreast: a rare condition – from diagnosis to treatment

“…It should be clinical observation, vacuum-guided excision or surgical excision and, in some selected cases, unilateral or bilateral mastectomy. The choice of the surgical modality can be based on the size of the lesion, the patient's desire and the surgeon's experience 8,27,28 .…”