Tumoral Pseudoangiomatous Stromal Hyperplasia of the Breast

• Published in: The American surgeon Vol. 74; no. 12; pp. 1211 - 1214
• Main Authors: WIEMAN, Stephanie M, LANDERCASPER, Jeffrey, JOHNSON, Jeanne M, ELLIS, Richard L, WESTER, Susan M, LAMBERT, Pamela J, ROSS, Lauren A
• Format: Journal Article
• Language: English
• Published: Atlanta, GA Southeastern Surgical Congress 01.12.2008; SAGE PUBLICATIONS, INC
• Subjects: Adolescent; Adult; Aged; Angiomatosis - pathology; Angiomatosis - surgery; Biological and medical sciences; Biopsy; Biopsy, Needle; Breast - pathology; Breast - surgery; Breast cancer; Breast Diseases - pathology; Breast Diseases - surgery; Female; General aspects; Histology; Humans; Hyperplasia - pathology; Hyperplasia - surgery; Mammography; Medical sciences; Middle Aged; Patients; Retrospective Studies; Stromal Cells - pathology; Studies; Ultrasonography, Mammary; Medicine; Treatment; Surgery; Hyperplasia; Breast; Stroma; Tumor; Mammary gland
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313480807401217

Tumoral pseudoangiomatous stromal hyperplasia (PASH) is a rare benign proliferative disease of the breast. The majority of the literature reports of PASH have not contained detailed descriptions of the imaging characteristics of PASH. A 10-year retrospective study of patients with tumoral PASH and a 20-year Ovid MEDLINE search were performed to determine whether specific imaging and needle biopsy results could characterize PASH preoperatively. We identified 22 patients with tumoral PASH. Seventeen (77%) of 22 women had a palpable lump and 14 (72%) of 21 had a density on mammography. Ultrasound (US) findings included mixed or hypoechoic echogenicity in 83 per cent and ill-defined borders in 62 per cent. Eight (36%) patients had lesions with a Breast Imaging Reporting and Data System (BI-RADS) classification of 4 or 5. The sensitivity of preoperative core needle biopsy (CNB) to identify PASH was 83 per cent. A review of the literature revealed that 90 per cent of patients with PASH had some malignant imaging characteristics and 95 per cent had a mass on mammography. The imaging characteristics of PASH exhibited marked variability. Excision of PASH after CNB may be considered for patients with symptoms, enlarging lesions, or lesions classified as BI-RADS 4 or 5. PASH diagnosed by CNB allows selected patients to avoid excision.