Pseudoangiomatous Stromal Hyperplasia Research Articles

Feasibility of Harmonic Motion Imaging Using a Single Transducer: In Vivo Imaging of Breast Cancer in a Mouse Model and Human Subjects.

Harmonic motion imaging (HMI) interrogates the mechanical properties of tissues by simultaneously generating and tracking harmonic oscillation using focused ultrasound and imaging transducers, respectively. Instead of using two transducers, the objective of this work is to develop a single transducer HMI (ST-HMI) to both generate and track harmonic motion at "on-axis" to the force for facilitating data acquisition. In ST-HMI, the amplitude-modulated force was generated by modulating excitation pulse duration and tracking of motion was performed by transmitting tracking pulses interleaved between excitation pulses. The feasibility of ST-HMI was performed by imaging two elastic phantoms with three inclusions (N = 6) and comparing it with acoustic radiation force impulse (ARFI) imaging, in vivo longitudinal monitoring of 4T1, orthotropic breast cancer mice (N = 4), and patients (N = 3) with breast masses in vivo. Six inclusions with Young's moduli of 8, 10, 15, 20, 40, and 60 kPa were embedded in a 5 kPa background. The ST-HMI-derived peak-to-peak displacement (P2PD) successfully detected all inclusions with [Formula: see text] of the linear regression between the P2PD ratio of background to inclusion versus Young's moduli ratio of inclusion to background. The contrasts of 10 and 15 kPa inclusions were higher in ST-HMI than ARFI-derived images. In the mouse study, the median P2PD ratio of tumor to non-cancerous tissues was 3.0, 5.1, 6.1, and 7.7 at 1, 2, 3, and 4 weeks post-injection of the tumor cells, respectively. In the clinical study, ST-HMI detected breast masses including fibroadenoma, pseudo angiomatous stromal hyperplasia, and invasive ductal carcinoma with a P2PD ratio of 1.37, 1.61, and 1.78, respectively. These results indicate that ST-HMI can assess the mechanical properties of tissues via generation and tracking of harmonic motion "on-axis" to the ARF. This study is the first step towards translating ST-HMI in clinics.

MRI features of pseudoangiomatous stromal hyperplasia with histopathological correlation.

Pseudoangiomatous stromal hyperplasia (PASH), a rare, noncancerous lesion, is often an incidental finding on magnetic resonance imaging (MRI)-guided biopsy analysis of other breast lesions. We sought to describe the characteristics of PASH on MRI and identify the extent to which these characteristics are correlated with the amount of PASH in the pathology specimens. We identified 69 patients who underwent MRI-guided biopsies yielding a final pathological diagnosis of PASH between 2008 and 2015. We analyzed pre-biopsy MRI scans to document the appearance of the lesions of interest. All biopsy samples were classified as having ≤50% PASH or ≥51% PASH present on the pathological specimen. On MRI, 9 lesions (13%) appeared as foci, 19 (28%) appeared as masses with either washout or persistent kinetics, and 41 (59%) appeared as regions of nonmass enhancement. Of this latter group, 33 lesions (80%) showed persistent kinetic features. Masses, foci, and regions of nonmass enhancement did not significantly correlate with the percentage of PASH present in the biopsy specimens (P≥.05). Our findings suggest that PASH has a wide-ranging appearance on MRI but most commonly appears as a region of nonmass enhancement with persistent kinetic features. Our finding that most specimens had ≤50% PASH supports the notion that PASH is usually an incidental finding. We did not identify a definitive imaging characteristic that reliably identifies PASH.

Hyperechoic Lesions on Breast Ultrasound: All Things Bright and Beautiful?

Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.

Pseudoangiomatous stromal hyperplasia of thebreast: a rare condition – from diagnosis to treatment

Pseudoangiomatous Stromal Hyperplasia (PASH) of the breast is a rare condition that consists of the proliferation of the breast myofibroblastic stromal cells, lining anastomosing vascular slit-like spaces. This condition is not considered a pre-malignant lesion and affects mainly premenopausal women. Its etiology is still uncertain, but its behavior points to a hormonal cause. It has a varied clinical presentation and can be diagnosed as an incidental finding of biopsies or with the manifestation of clinical signs and symptoms. As for the diagnosis, it can be performed with the correlation between clinical data, imaging and histopathological analysis. Due to its rare nature, there are still no prospective studies regarding treatment, but, in most cases, clinical and radiological follow-up is a safe strategy. The aim of this paper is to synthesize the data available in the literature about this condition, which, although benign in nature, can bring important aesthetic, musculoskeletal and psychological repercussions.

Testosterone therapy and breast histopathological features in transgender individuals

Testosterone therapy (TT) is administered to enhance masculinization in transgender individuals. The long-term effect of exogenous testosterone on breast tissues remains unclear. Our study evaluated the modulation of breast morphology by TT in transgender individuals with special attention to duration of TT. We reviewed 447 breast surgical specimens from gender affirming chest-contouring surgery, and compared histopathological findings including degree of lobular atrophy, and atypical and non-atypical proliferations between subjects who did (n = 367) and did not (n = 79) receive TT. TT for one patient was unknown. TT for >12 months was associated with seven histopathological features. Longer duration of TT was significantly associated with higher degrees of lobular atrophy (p < 0.001). This relationship remained significant after accounting for age at surgery, ethnicity, body mass index, and presurgical oophorectomy (adjusted p < 0.001). Four types of lesions were more likely to be absent in breast tissues exposed to longer durations of TT: cysts (median = 16.2 months; p < 0.01; adjusted p = 0.01), fibroadenoma (median = 14.8 months; p = 0.02; adjusted p = 0.07), pseudoangiomatous stromal hyperplasia (median = 17.0 months; p < 0.001; adjusted p < 0.001), and papillomas (median = 14.7 months; p = 0.04; adjusted p = 0.20). Columnar cell change and mild inflammation were also less likely to occur in subjects receiving TT (p < 0.05), but were not linked to the duration of TT. Atypia and ductal carcinoma in situ were detected in 11 subjects (2.5%) all of whom received TT ranging from 10.1 to 64.1 months. The incidental findings of high-risk lesions and carcinoma as well as the risk of cancer in residual breast tissue after chest-contouring surgery warrant the consideration of culturally sensitive routine breast cancer screening protocols for transgender men and masculine-centered gender nonconforming individuals. Long-term follow-up studies and molecular investigations are needed to understand the breast cancer risk of transgender individuals who receive TT.

Our experience in surgical treatment of bilateral pseudoangiomatous stromal hyperplasia in children with gigantomastia

Our experience in surgical treatment of bilateral pseudoangiomatous stromal hyperplasia in children with gigantomastia

Pseudoangiomatous stromal hyperplasia: overview and clinical management

: Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal lesion of the breast characterized by dense collagenous stroma forming “pseudoangiomatous” capillary-like spaces lined by slender spindle cells. A rare condition overall, PASH is most common in premenopausal women, though cases have been described at ages ranging from 14 to 86, and in men, usually associated with gynecomastia. While the exact etiology is unknown, PASH is considered hormonally responsive, with myofibroblastic proliferation leading to stromal hyperplasia. It may present as a palpable mass or an incidental imaging finding. The usual appearance on mammography and ultrasound is that of a well-circumscribed mass which must be differentiated from other benign and malignant lesions such as fibroadenoma, phyllodes tumor, and myofibroblastoma; histologically it must be distinguished from angiosarcoma. Core needle biopsy is indicated for diagnosis and must be concordant with imaging and clinical findings. PASH lesions should be surgically excised if enlarging, associated with symptoms, suspicious imaging findings are present, or other lesions are synchronously diagnosed that warrant removal; otherwise, observation with clinical and imaging follow-up can be considered. Progression and recurrence, each reported at rates of approximately 15–20%, indicate change in management and/or additional surgical intervention. PASH is not associated with an increased risk of breast cancer and prognosis is generally favorable.

The effect of hormones on an uncommon breast disorder pseudoangiomatous stromal hyperplasia: a case report and literature review.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of the breast, with few cases reported to date. While the etiology of the disease is uncertain, a prevailing theory is that PASH is hormonally responsive, especially in the presence of progesterone. Literature review shows a correlation between PASH development and oral contraceptive pill (OCP) use. We report a case of a 28-year-old autistic female who underwent excision of palpable bilateral breast masses where the histology of the left breast mass identified as PASH. Our patient had a history of multiple medications including OCPs and cytochrome p450 inhibitors that could lead to an increase in progesterone levels. Thus, supporting a theory that medications, in addition to OCPs, may lead to an increased occurrence of PASH in pre-menopausal women.

Histologic Correlation of Breast Biopsies Presenting as Non-Mass Enhancing Lesions on Magnetic Resonance Imaging: A Contemporary Single Institutional Series

Abstract Introduction/Objective Non-mass enhancement (NME) in breast tissue is an area of enhancement on MRI that appears distinct from background breast parenchyma, but lacks definitive features of a mass. NME is characterized by its internal enhancement pattern and distribution, and can represent benign, high risk, or malignant pathology. Given this considerable overlap, a core biopsy is often necessary for diagnosis and management. We aimed to elucidate the most frequent histologic findings found on breast biopsies for MRI NME. Methods Using our institutional database we identified 70 female patients with high risk status for breast cancer with MRI screen detected NME (BIRADS-4-suspicious for malignancy) that underwent subsequent biopsy procedure during the period of 01/2016-12/2017. Primary pathologic diagnoses were subcategorized as follows: malignant, atypical, benign mass-like lesions, fibrocystic changes (proliferative, nonproliferative), or “other” primary diagnoses. Results The median age of patients was 48 years (range: 22-76 years). Of the 70 patients, 66 underwent MRI-guided core biopsy, 3 underwent ultrasound-guided core biopsy and 1 underwent excisional biopsy. The primary diagnosis was analyzed. Of these 70 cases, 8 (11.4%) were malignant (7 with ductal carcinoma in situ and 1 with invasive ductal carcinoma), 1 (1.4%) had atypical lobular hyperplasia, and the remaining 61 (87.1%) showed benign findings (36 with fibrocystic changes (FCC), 22 benign mass-like lesions, 3 with other non-specific findings). The FCC were subcategorized as proliferative (usual ductal hyperplasia, columnar cell change, incidental radial scar, incidental intraductal papilloma, sclerosing adenosis, focal pseudoangiomatous stromal hyperplasia (PASH)) or nonprolifeative (stromal fibrosis, duct ectasia, apocrine metaplasia). Majority (61.1%) of FCC were both proliferative and nonproliferative, 22.2% proliferative only and 16.7% nonproliferative only. Benign mass-like lesions included PASH (45.4%), fibroadenomatoid nodule (22.7%), fat necrosis (18.2 %) and remaining had the diagnosis of clustered apocrine cysts, papillomatosis, and radial sclerosing lesion. Conclusion Less than a third of cases showed malignant findings and more than two-third of cases showed benign findings with a high rate of detection of proliferative lesions and PASH.

Tumoural pseudoangiomatous stromal hyperplasia and angiomatosis of the breast in the same tumour: An unprecedented association.

Tumoural pseudoangiomatous stromal hyperplasia and angiomatosis of the breast in the same tumour: An unprecedented association.

Abstract B118: Characteristics of patients with pseudoangiomatous stromal hyperplasia (PASH): A retrospective cohort study

Abstract Background: Pseudoangiomatous stromal hyperplasia (PASH) is a proliferative mesenchymal lesion of the breast histologically defined by dense collagenous stroma with spindle-shaped myofibroblasts. Characterization of patients with PASH has largely been limited to histologic and radiographic studies with small sample sizes due to the rarity of this benign condition. Furthermore, no existing studies of PASH have yet to consider race. Objectives: We undertook this study to identify subjects with PASH from electronic medical records (EMR) at the Vanderbilt University Medical Center (VUMC) and evaluate patient characteristics, including differences by race. Approach: We used natural language processing (NLP)-assisted searches to identify 283 subjects with pathology reports containing ‘PASH’ or ‘pseudoangiomatous stromal hyperplasia’. Results: We confirmed PASH by pathology report for 229 subjects (80.9%). The majority were Caucasian women, although 24 African Americans (10.5%) and 4 males (1.7%) with PASH were also identified. A total of 27 (11.8%) had a diagnosis of cancer as some point in their EMR, most frequently breast (74.1%) or thyroid (14.8%) cancer. The median age at PASH diagnosis was 45.4 years (range: 12.9-84.6) but this seemed lower among Asians (31.4 years). PASH was found more frequently in the left breast (54.8%) and was ascertained most often by core needle biopsy (76.0%), stereotactic needle biopsy (11.8%), or excision (7.0%). Among initially biopsied patients, 20 (9.9%) and 39 (19.3%) had subsequent biopsies and excisions, respectively. No significant differences in any of these characteristics by race were identified. Conclusions: This data confirms that PASH is not exclusive to Caucasians and suggests that patient characteristics do not differ by race. Analysis of additional characteristics and patient outcomes, with inclusion of EMR time, is currently underway. Citation Format: George Bukenya, Demetra Hufnagel, Nneka Anyawu, Stephanie Kurita, Alicia Beeghly-Fadiel. Characteristics of patients with pseudoangiomatous stromal hyperplasia (PASH): A retrospective cohort study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B118.

Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: An Uncommon Finding in an Uncommon Patient

Patient: Female, 30-year-oldFinal Diagnosis: Pseudoangiomatous stromal hyperplasia (PASH)Symptoms: Breast massMedication: —Clinical Procedure: LumpectomySpecialty: Obstetrics and GynecologyObjective:Unknown ethiologyBackground:Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign breast lesion.Case Report:PASH is reported in a young female in treatment for neurological diseases with multi-drug therapy (clonazepam, valproate and risperidone). Her menstrual cycles are irregular, and she reached menarche very late.Conclusions:The higher PASH prevalence in premenopausal woman (the majority of whom are actively taking oral contraceptive pills), in 24% to 47% of men with gynecomastia and during pregnancy supports a hormonal etiology; the interaction between clonazepam, valproate, risperidone and progesterone could increase the level of progesterone that could stimulate PASH growth.

Bilateral diffuse pseudoangiomatous stromal hyperplasia in a pregnant woman: case report

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of breast stroma, usually described as an incidental microscopic finding. Clinically, it can manifest as a palpable and well-circumscribed mass or, in rare cases, as a diffuse bilateral process, causing massive and rapid breast growth. The most widely accepted theory about PASH is the hormonal stimulation of breast myofibroblasts, mainly caused by progesterone. A definitive PASH diagnosis is based on typical findings, such as stromal hyperplasia and slit-like channels. The main clinical differential diagnosis is fibroadenoma or phyllodes tumor and, histologically, low-grade angiosarcoma. This work aims at evaluating the maternal and fetal prognosis of a diffuse PASH case in a pregnant woman. This is the case report of a 27-year-old woman with no comorbidities, previously diagnosed with PASH in January 2018, without clinical repercussion or treatment at the time. In 2019, in the 16th week of her second pregnancy, she noticed a rapid and significant breast growth. In the first trimester, she had a weight gain of 12 kg, and her breasts had a four-fold volume increase, preventing her from performing routine activities, such as standing and walking. Over the days, still with progressive breast tissue growth, she showed a considerable reduction in peripheral breast vascularity, intense pain, hyperemia, skin necrosis, overall worsening, and hemodynamic repercussion. Since this is a case little reported in the literature and given the clinical and hemodynamic conditions of the patient, the treatment chosen was bilateral mastectomy, performed with her consent in October 2019. In the immediate postoperative period, she progressed to fetal death and hemodynamic stabilization in the intensive care unit. After a few days of hospitalization, stable, and with good progress, she was discharged for outpatient follow-up. Anatomopathological results corroborated the PASH diagnosis made in 2018. Data on the final pregnancy outcome and the consequences for mother and fetus will be reported. Data analysis was based on a review of the patient's medical records. We concluded that each case should be assessed individually, taking into account the clinical, surgical, and obstetric aspects to determine the best workup and therapeutic approach.

Association of a large vulvar tumor in a in a young premenopausal woman with recurrent pseudoangiomatous stromal hyperplasia of the breasts

Pseudoangiomatous stromal hyperplasia is a benign proliferative lesion of the breast tissue that typically affects women in the reproductive age. Pseudoangiomatous stromal hyperplasia usually presents as a localized, painless, firm mass or as a diffuse thickened area of the breast. Rarely, it can arise along the embryonic milk line, up to the anogenital region, where it simulates angiosarcomas. Awareness of this uncommon condition is important in order to avoid unnecessary aggressive excisional surgical procedures. For this purpose, we present a case of nodular pseudoangiomatous stromal hyperplasia arising in the vulva in a patient with recurrent pseudoangiomatous stromal hyperplasia of the breast.

Clinicopathological analysis of seven breast hamartomas and review of the literature

Aim: Breast hamartomas are uncommon benign lesions that constitute 4.8% of benign breast tumors; they consist of mammary ducts and lobules, fatty tissue, and fibrous tissue. The aim of this study was to determine the clinical and pathological characteristics of breast hamartomas diagnosed by surgical resection and to examine the accompanying lesions. Material and Methods: Patients who underwent breast surgery between January 2013 and January 2018 at Konya Education and Research Hospital and who were diagnosed as having breast hamartomas were reviewed retrospectively. Results: Seven breast hamartomas were identified. All of them were female. The mean age was 45 years. The mean tumor size was 3.9 cm. Most of the lesions were located in the right breast (57.1%). All the hamartomas appeared in the upper part of the breast. Five of the seven cases were admitted with a painless palpable mass in the breast (71.4%). Three of the seven cases were myoid hamartomas. The type of lesion most commonly associated with breast hamartomas is cyst formation. Pseudoangiomatous stromal hyperplasia, columnar cell hyperplasia, and ductal epithelial hyperplasia are also common. Ductal epithelial hyperplasia and columnar cell hyperplasia were observed in all the myoid hamartomas. Ductal carcinoma in situ was detected in one case; it was also a myoid hamartoma. Conclusions: Breast hamartomas are accompanied by many types of lesions such as fibrocystic changes, adenosis, ductal epithelial hyperplasia, and pseudoangiomatous stromal hyperplasia. In addition to these lesions, columnar cell hyperplasia was also identified. Malignancies are rarely detected in breast hamartomas; however, one case of ductal carcinoma in situ in a myoid hamartoma was detected.

Pseudoangiomatous stromal hyperplasia of the breast presenting as gigantomastia: case report

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign condition generally seen as an incidental finding of biopsies for other causes. In some rare cases, it can evolve with expressive growth of breast tissue, leading to large breasts. The present study presents a case report of a patient who started with breast hypertrophy during lactation, evolving with gigantomastia, and arrived at the office 3 years after gestation with breasts of 6.2 and 4.3 kg and growth of accessory breast and axillary lymph nodes. The patient was emaciated, with bodily pain and psychological distress. Computed tomography was performed with the finding of diffuse retroglandular nodules and axillary and mediastinal lymph node enlargement, without being able to rule out the lymphoproliferative process. Then, core biopsies were made in several places on the breast whose pathological examination revealed PASH samples. Bilateral mastectomy was performed as a surgical treatment, with resection of the left accessory breast and left axillary lymph node, and breast reconstruction, with placement of silicone prostheses and graft of the areola-papillary complex, together with a plastic surgeon. She evolved in the postoperative period with good healing of the surgical wound, weight gain, necrosis of the areola-papillary complex and with severe psychiatric disorder, which was treated appropriately by psychiatrists, with remission of symptoms. This case report presents a rare evolution of PASH with gigantomastia, bringing intense physical and psychological distress to the patient, whose treatment chosen was total surgical resection of the breast tissue and aesthetic reconstruction.

A Case of Pseudoangiomatous Stromal Hyperplasia Affected a 19-year-old Woman and Tended to Grow

A Case of Pseudoangiomatous Stromal Hyperplasia Affected a 19-year-old Woman and Tended to Grow

Optimal treatment of pseudoangiomatous stromal hyperplasia of the breast

Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. Owing to the rarity of PASH, the pathogenesis, clinical manifestation, and optimal treatment of this condition remain unclear. We aimed to clarify the appropriate management of PASH. We performed a retrospective analysis of the clinicopathological data of 66 cases with a diagnosis of PASH, confirmed by core needle biopsy (CNB) or surgical excision at Severance Hospital between 2000 and 2016. The primary endpoint was pathologic results after surgical excision of the lesion that confirmed PASH by CNB. The secondary endpoint was progression after the first treatment. The median age of patients was 41 years (range, 14-61 years). Findings on medical imaging were nonspecific. CNB was performed in 61 cases, with a diagnosis of PASH confirmed in 39 cases (63.9%). No malignant or premalignant cells directly arising from PASH were identified after surgical excision that confirmed PASH via CNB. The progression rate after the first treatment was 16.6%, with lesion size, enlargement of palpable mass size, and a diagnosis other than PASH on CNB being factors associated with progression. CNB is sufficient to confirm PASH what is necessary for an abnormal imaging or suspicious physical examination finding. Surgical excision is not necessarily indicated to rule out occult malignancy after a diagnosis of PASH. Close monitoring or surgical excision are required to manage large lesions (>3cm) or progressive growth of a PASH lesion.

A rare case of breast intracanalicular fibroadenoma associated with pseudoangiomatous stromal hyperplasia in a 11-year-old female

A rare case of breast intracanalicular fibroadenoma associated with pseudoangiomatous stromal hyperplasia in a 11-year-old female

Our 20-Year Institutional Experience with Surgical Approach for Breast Hamartomas.

Hamartomas are rare, slowly-growing breast tumours. Clinical, radiological and histopathological examination together increase the diagnostic accuracy. To evaluate the clinicopathologic features of hamartomas and outline our clinical approach to hamartomas in our 20-year experience at our Breast Clinic. Between 1995 and 2015, 24 cases were retrospectively analyzed with a diagnosis of breast hamartoma at our Breast Clinic followed by excisional biopsy. Data was obtained on patient demographics, clinical examination, radiological findings and histopathological subtypes. Of 1338 benign breast tumours excised from January 1995 to January 2015, 24 (1.8%) were identified as breast hamartoma. Median age of patients was 42 (range, 13-70), whereas the median tumour size was 5 cm (1-10 cm). On preoperative imaging, hamartoma was most commonly misdiagnosed as fibroadenoma. Pathological examination of the 24 biopsy specimens revealed 3 cases with pseudoangiomatous stromal hyperplasia, and another hamartoma associated with a radial scar within the centre of the lesion. Of those, one patient was diagnosed with malignant phylloides tumour in the same breast. At a median follow-up 58.4 months, none of the patients recurred or developed malignancy. Hamartomas can often be missed by clinicians, due to its benign nature which is poorly understood. Despite their slow growth, hamartomas can reach large sizes and can cause breast asymmetry. Although it is rare, hamartoma can be seen along with malignancy, as it is formed from similar components of breast tissue. Therefore, careful diagnosis and appropriate management including surgery are required.