PASH

Mimickers of
breast malignancy: imaging findings, pathologic concordance and clinical management. Pseudoangiomatous stromal hyperplasia. A 41-year-old woman presented with a palpable breast mass. Mediolateral oblique mammogram (a) shows a high-density well-circumscribed mass (arrow). Longitudinal grayscale ultrasound (b) shows a large, oval circumscribed mass. Core needle biopsy showed pseudoangiomatous stromal hyperplasia (PASH). A different patient, a 40-year-old woman, was found to have a new breast mass (arrow) on mammography, craniocaudal spot view (c). Transverse grayscale (d) ultrasound reveals a corresponding oval isoechoic circumscribed mass. Core needle biopsy showed PASH
insightsimaging.springeropen.com • CC-by-4.0
Mimickers of
breast malignancy: imaging findings, pathologic concordance and clinical management. Suspicious presentation of pseudoangiomatous stromal hyperplasia. A 56-year-old woman with a new focal asymmetry in the outer breast that was identified on her (a) screening mammogram and persisted on (b) additional diagnostic spot compression views (arrows). The area was palpable by the patient and the clinician. The focal asymmetry had developed since her prior available mammogram performed 4 years earlier (c). Breast ultrasound (d) shows a corresponding irregular hypoechoic mass with associated posterior acoustic shadowing (arrow). Breast MRI sagittal post-contrast T1-weighted delayed images (e) and axial post-contrast T1-weighted images (f) show irregular enhancing masses (arrows). Corresponding T2 hyperintense cystic components with slit-like spaces (arrow) are identified (g), which favors PASH when present. Ultrasound-guided and MRI-guided biopsies were performed in this case and showed PASH. The area remained mammographically stable for over 4 years
insightsimaging.springeropen.com • CC-by-4.0
Pseudoangiomatous
stromal hyperplasia • Pseudoangiomatous stromal hyperplasia - Ganzer Fall bei Radiopaedia
Holland M, Pseudoangiomatous stromal hyperplasia. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-19309 • CC by-nc-sa 3.0 (modified)
Pseudoangiomatous
stromal hyperplasia • Pseudoangiomatous stromal hyperplasia (PASH) - Ganzer Fall bei Radiopaedia
Shehata M, Pseudoangiomatous stromal hyperplasia (PASH). Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-64276 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Pseudoangiomatous stromal hyperplasia (PASH) is a benign, relatively uncommon form of stromal (mesenchymal) overgrowth within breast tissue that derives from a possible hormonal etiology.

Epidemiology

Typically affects women of reproductive age. It rarely affects males.

Clinical presentation

The tumoral form of PASH commonly manifests as a single, circumscribed, palpable mass in a premenopausal female. The mass can be large (5-6 cm in diameter), with reported diameters ranging from 1-12 cm.

Pathology

It represents a clinicopathologic spectrum ranging from focal, incidental microscopic findings to clinically and mammographically evident breast masses. The development of PASH is presumed to be related to the interaction of progesterone in estrogen-activated tissue, and involved tissue contains estrogen and progesterone receptors. Lesions can be microscopic or nodular (tumourous).

Macroscopic appearance

On a gross pathological cut slice, tumourous PASH is typically a well-circumscribed, firm, rubbery mass with solid, homogenous, grey-white cut surface.

Microscopic appearance

PASH can be a relatively common incidental finding at breast biopsy. On histology, it is characterized by the presence of open slit-like spaces in dense collagenous stroma which is lined by a discontinuous layer of flat, spindle-shaped myofibroblasts with bland nuclei. It can also contain complex anastomosing spaces that may be confused with a low-grade angiosarcoma at histologic analysis .

Radiographic features

Imaging features are not sufficiently specific to allow for a prospective diagnosis. Histological confirmation, preferably with a core biopsy, should always be considered .

Mammography

Most often it is a circumscribed or partly circumscribed mass. However, they often present as an asymmetry/focal asymmetry . Lesions typically lack calcification .

Ultrasound

Most often it is an oval or round circumscribed mass. Often hypoechoic and may be slightly heterogeneous . Imaging appearance may be similar to that of fibroadenoma.

MRI

Features are often non-specific. Lesions may present as clumped non-mass-like regions of persistent enhancement on contrast-enhanced imaging .

Treatment and prognosis

Although mass lesions in PASH often grow over time and may recur after excisional biopsy in 10% of cases, they are neither associated with malignancy nor considered to be premalignant lesions .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Pseudoangiomatöse-Stroma-Hyperplasie (PASH):
Fibroadenom
 
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