Pseudoangiomatous Stromal Hyperplasia of Breast: A Case Report

Abstract

Aim: To present a case of pseudoangiomatous stromal hyperplasia (PASH) and its fi ndings under 1. mammography -MG, 2. ultrasonography -USG and 3. magnetic resonance imaging -MRI.Materials and methods: A woman 39 years of age with a history of mass in her right breast of 3 months duration was subjected to a routine examination of the mass using MG & USG. According to the modality fi ndings a core cut biopsy was done following which the samples were send for histological analysis. Later, MRI was done as advocated by the surgeon to get a better picture of the extent of the lesion prior to surgery.Results: Bilateral mammogram views revealed in the patient's right breast a huge well-bordered tumour of lobulated contour without halo sign. Sonography revealed a big well-demarcated tumour in the central part of the right breast which was cystic and lobulated in shape. Histological analysis of the sample confi rmed pseudoangiomatous stromal hyperplasia (PASH). MRI under a breast array coil revealed a mass of 85×75×35mm in the right breast. Finally, based on the clinical, radiological and histological report the mass was diagnosed as benign and despite the massive size of the mass, tumour excision alone was done and not mastectomy. The right breast after the huge tumour excision was almost normal in size compared to the left.Conclusion: PASH should be included in the diff erential diagnosis of a circumscribed or partially circumscribed mass, especially in the pre-menopausal female population. These benign masses often grow over time and can recur locally. Radiological diagnosis of PASH is usually done by MG and USG followed by core cut biopsy for histological analysis. However great the mass is, excision only of the tumor mass is recommended and not mastectomy.

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

“…Despite the fact that bilateral nodular cases of PASH are reported in the English medical literature, contrary to our patient, women of those cases have been mostly presented with more growth of one of the breasts causing significant asymmetry [ 1 , 17 – 19 ]. Also, it is common to find cases coursing with unilateral processes, or with a unique round mass that resembles a fibroadenoma or a phyllodes tumor [ 9 , 20 – 23 ].…”

Multifocality, Multicentricity, and Bilaterality of Breast Cancer

“…Breast lesions which often present as bilateral are DCIS [30], Paget's disease of the nipple, radial scars and complex sclerosinglesions, gynecomastia, Burkitt lymphoma [31], while bilateral breast cancer also frequently occurs in patients with Cowden syndrome and heterozygous ATM mutation carriers (ataxia telangiectasia), as a result of submitting patients suffering from Louis-Bar syndrome to radiotherapy [31][32][33]. Other types of potentially bilateral-onset breast lesions are atypical ductal hyperplasia [31], phyllodes tumour [32,34], myofibroblastoma [33], desmoidfibromatosis [35], male breast cancer [36], angiosarcoma [37,38], liposarcoma [31], lymphoma (about 10% of the cases), pseudoangiomatous stromal Multifocality, Multicentricity, and Bilaterality of Breast Cancer DOI: http://dx.doi.org/10.5772/intechopen.96489 hyperplasia [39], ductal adenoma in patients with Carney syndrome [40]. There are also lesions with unidentified bilaterality, some of which are ALK-negative anaplastic large cell lymphoma [31], mucosa associated lymphoid tissue lymphoma [41] and granular cell tumour [42].…”