Hamartoma Associated to Pseudoangiomatous Stromal Hyperplasia (Pash) of the Breast and Chondroid Metaplasia

Abstract

INTRODUCTION: Hamartoma of the breast is rare benign lesion, generally detected through the screening mammographic. PURPOSE: Case report of two rare histopathological alterations in the breast: PASH and Chondroid metaplasia associated to the hamartoma. For the attention of us, in this case was the compound of “chondroid metaplasia” (unusual in benign lesion) associated PASH that is histologically benign myofibroblastic proliferation of mammary stroma, and complex network of anastomosing slit-like spaces within a dense collagenous stroma. REPORT: RCM, female, 47 years old, history of the left breast nodule painless, for 5 years ago, detected by mammographic screening. Physical exam: right breast without palpable tumour. Left breast: size nodule 5. 0mm in inferomedial quadrant (IMQ), elastic, mobile, free skin and deep plans surface localized in junction medial quadrants (JMQ), Axillary lymph nodes uninvolved. MMG: ovale hyperdense nodule, margins partially defined, associated with calcifications, measuring 45mm in IMQ left breast BIRADS zero. USG: Heterogeneous nodular image, irregular with calcifications measuring 59 per 33 per 44 mm, localized at 9 o’clock position left breast. Core biopsy: PASH and cartilagenous differentiation. It was suggested total resection of lesion. Freezing exam: its didn’t conclude. Surgical pathological report: left breast quadrant, mammary hamartoma, chondroid metaplasia, and PASH with tubular microcystic adenosis and fat. Immunohistochemical: positive P63 and Calponin in the myo-epithelial cells. Immunohistochemical profile together morphological findings consistent to mammary hamartoma. DISCUSSION: Hamartoma has been incidence of 0. 1-0. 7%, average 45 years old, in the mammographic shows circumscribed lesion lobular pseudocapsular and heterogenous density. The classical mammography appearance is circumscribed area consisting of both soft tissue and lipomatous elements, surrounded by a thin radiolucent zone. Despite the pathogenic of the lesion is not clear, it’s thought to result from a mesenchymal dysgenesis rather than a true tumoral process. Histologically, the most characteristic is appearance otherwise normal breast and fat tissue distributed in a nodular fashion within a fibrous stroma. Some cases have been reported to a genetic defect named Cowden’s disease. The current management of hamartoma is surgical removal. CONCLUSION: The aim of this report was the presents rare hamartoma benign breast lesion associated to chondroid metaplasia, uncommon lesions that leads us to do a differential diagnostic with fibroadenoma and benign phyllodes tumours, as well PASH areas although benign lesion that histologically need the differential diagnosis with low grade mammary angiosarcoma. The patient is very well and she is in follow up uneventful.