Mammary Pseudoangiomatous Stromal Hyperplasia

Ng, Wai-Kuen; Chiu, Conrad S. C.; Han, Kam-Chu; Chow, Janson C. Y.

doi:10.1159/000326536

Cited by 23 publications

(1 citation statement)

References 22 publications

(22 reference statements)

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“…If cysts are present, they are small; up to 1 cm. 5,30 On histology PASH is characterised by collagenous proliferation of the stroma, with small groups of spindle-shaped myofibroblasts. These spindle-shaped cells are arranged along non-vascular slit-like spaces, which are created from disruption and separation of stromal collagen fibers.…”

Section: Discussionmentioning

confidence: 99%

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

2012

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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.

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Section: Discussionmentioning

confidence: 99%

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

2012

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Aspiration biopsy of nodular pseudoangiomatous stromal hyperplasia of the breast: Clinicopathologic correlates in 10 cases

Nimeh

Guth

et al. 2005

Diagn. Cytopathol.

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Nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast is rare and often indistinguishable from fibroadenoma, clinically and on aspiration biopsy smears. We report our observations in 10 patients with PASH, evaluated by fine-needle aspiration (FNA) biopsy and core biopsy. We retrospectively reviewed the clinical, radiographic, cytologic, and histologic findings in 10 cases of pure nodular PASH. Ten patients with a presumed clinical and radiologic diagnosis of fibroadenoma underwent aspiration biopsy. The aspiration smears were diagnosed as fibroadenoma (4 cases), cellular fibroadenoma (1 case), schwannoma versus neurofibroma (1 case), fibrocystic change (3 cases; 2 with atypia), and "not specific for a lesion" (1 case). A diagnosis of PASH was not suspected in any case. A discrepant or imprecise cytologic diagnosis and/or the presence of dissociated spindle or epithelial cells, or cellular stromal fragments prompted a surgical excision in 7 of 10 patients (70%). The remaining 3 patients exhibited cytologic features of fibroadenoma and were diagnosed as such; however, surgical excision was recommended. Three patients underwent a subsequent core biopsy, with a diagnosis of PASH being made in 1 patient. FNA biopsy could not discriminate PASH from fibroadenoma in 4 of 10 patients (40%) or suggest a diagnosis of PASH in any case. On retrospective review, the finding of plump, spindle-shaped mesenchymal cells may be a cytologic clue to suggest a diagnosis of PASH.

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Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses

Khattab

Rowe

Booth

et al. 2019

Diagnostic Cytopathology

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The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the “Yokohama System”), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo‐cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.

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Mammary Pseudoangiomatous Stromal Hyperplasia

Cited by 23 publications

References 22 publications

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

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

Aspiration biopsy of nodular pseudoangiomatous stromal hyperplasia of the breast: Clinicopathologic correlates in 10 cases

Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses

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