Pseudoangiomatous stromal hyperplasia: Difference between revisions
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| Caption = Pseudoangiomatous stromal hyperplasia. [[H&E stain]]. | | Caption = Pseudoangiomatous stromal hyperplasia. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = abundant breast stroma, small complex inter-anastomosing (blood vessel/capillary-like) channels | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[fibroadenoma]], low-grade [[angiosarcoma]] | | LMDDx = [[fibroadenoma]], low-grade [[angiosarcoma]] | ||
| Stains = Bcl-2 +ve, vimentin +ve, CD34 | | Stains = Bcl-2 +ve, vimentin +ve, CD34 +ve, SMMHC +ve, CD31 -ve, factor VIII -ve | ||
| IHC = | | IHC = | ||
| EM = | | EM = | ||
| Line 28: | Line 28: | ||
| Other = | | Other = | ||
| ClinDDx = [[fibroadenoma]] | | ClinDDx = [[fibroadenoma]] | ||
| Tx = excision | | Tx = followup or excision | ||
}} | }} | ||
'''Pseudoangiomatous stromal hyperplasia''', abbreviated ''PASH'', is benign lesion is [[breast pathology]]. | '''Pseudoangiomatous stromal hyperplasia''', abbreviated ''PASH'', is benign lesion is [[breast pathology]]. | ||
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*Benign lesion. | *Benign lesion. | ||
*Thought to arise due to myofibroblast abnormality - though not well understood.<ref name=pmid7872425>{{cite journal |author=Powell CM, Cranor ML, Rosen PP |title=Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation |journal=Am. J. Surg. Pathol. |volume=19 |issue=3 |pages=270–7 |year=1995 |month=March |pmid=7872425 |doi= |url=}}</ref> | *Thought to arise due to myofibroblast abnormality - though not well understood.<ref name=pmid7872425>{{cite journal |author=Powell CM, Cranor ML, Rosen PP |title=Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation |journal=Am. J. Surg. Pathol. |volume=19 |issue=3 |pages=270–7 |year=1995 |month=March |pmid=7872425 |doi= |url=}}</ref> | ||
*An incidental finding ''or'' occasionally a mass.<ref name=pmid21862488>{{Cite journal | last1 = Drinka | first1 = EK. | last2 = Bargaje | first2 = A. | last3 = Erşahin | first3 = ÇH. | last4 = Patel | first4 = P. | last5 = Salhadar | first5 = A. | last6 = Sinacore | first6 = J. | last7 = Rajan | first7 = P. | title = Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a clinicopathological study of 79 cases. | journal = Int J Surg Pathol | volume = 20 | issue = 1 | pages = 54-8 | month = Feb | year = 2012 | doi = 10.1177/1066896911418643 | PMID = 21862488 }}</ref> | |||
*May be suspicious on imaging ([[BI-RADS]] 4 or 5).<ref name=pmid19097540>{{Cite journal | last1 = Wieman | first1 = SM. | last2 = Landercasper | first2 = J. | last3 = Johnson | first3 = JM. | last4 = Ellis | first4 = RL. | last5 = Wester | first5 = SM. | last6 = Lambert | first6 = PJ. | last7 = Ross | first7 = LA. | title = Tumoral pseudoangiomatous stromal hyperplasia of the breast. | journal = Am Surg | volume = 74 | issue = 12 | pages = 1211-4 | month = Dec | year = 2008 | doi = | PMID = 19097540 }}</ref> | |||
*May be followed (expectant management) or (surgically) excised.<ref name=pmid20887819>{{Cite journal | last1 = Jaunoo | first1 = SS. | last2 = Thrush | first2 = S. | last3 = Dunn | first3 = P. | title = Pseudoangiomatous stromal hyperplasia (PASH): a brief review. | journal = Int J Surg | volume = 9 | issue = 1 | pages = 20-2 | month = | year = 2011 | doi = 10.1016/j.ijsu.2010.09.005 | PMID = 20887819 }}</ref> | |||
==Gross== | ==Gross== | ||
Features:<ref name=pmid7872425>{{cite journal |author=Powell CM, Cranor ML, Rosen PP |title=Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation |journal=Am. J. Surg. Pathol. |volume=19 |issue=3 |pages=270–7 |year=1995 |month=March |pmid=7872425 |doi= |url=}}</ref> | Features:<ref name=pmid7872425>{{cite journal |author=Powell CM, Cranor ML, Rosen PP |title=Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation |journal=Am. J. Surg. Pathol. |volume=19 |issue=3 |pages=270–7 |year=1995 |month=March |pmid=7872425 |doi= |url=}}</ref> | ||
*May form mass | *May form mass. | ||
**Grey-white & firm. | |||
**Well-circumscribed borders. | |||
==Microscopic== | ==Microscopic== | ||
| Line 50: | Line 55: | ||
Notes: | Notes: | ||
*May mimic angiosarcoma at low power; PASH may have the same architecture but lack nuclear atypia. | *May mimic angiosarcoma at low power; PASH may have the same architecture but lack nuclear atypia. | ||
*Occasionally has mitotic activity - ''proliferative PASH''. | |||
DDx: | DDx: | ||
| Line 57: | Line 63: | ||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image: | Image:Pseudoangiomatous stromal hyperplasia -a- low mag.jpg | PASH - low mag. (WC/Nephron) | ||
Image: | Image:Pseudoangiomatous stromal hyperplasia -a- intermed mag.jpg | PASH - intermed. mag. (WC/Nephron) | ||
Image: | Image:Pseudoangiomatous stromal hyperplasia -a2- intermed mag.jpg | PASH - intermed. mag. (WC/Nephron) | ||
Image:Pseudoangiomatous stromal hyperplasia -a- high mag.jpg | PASH - high mag. (WC/Nephron) | |||
</gallery> | |||
<gallery> | |||
Image:Pseudoangiomatous stromal hyperplasia - intermed mag.jpg | PASH - intermed. mag. (WC/Nephron) | |||
Image:Pseudoangiomatous stromal hyperplasia - high mag.jpg | PASH - high mag. (WC/Nephron) | |||
Image:Pseudoangiomatous stromal hyperplasia - very high mag.jpg | PASH - very high mag. (WC/Nephron) | |||
</gallery> | </gallery> | ||
www: | www: | ||
*[ | *[https://www.nature.com/articles/3801003/figures/2 PASH (nature.com)].<ref name=pmid18084246>{{Cite journal | last1 = Ferreira | first1 = M. | last2 = Albarracin | first2 = CT. | last3 = Resetkova | first3 = E. | title = Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases. | journal = Mod Pathol | volume = 21 | issue = 2 | pages = 201-7 | month = Feb | year = 2008 | doi = 10.1038/modpathol.3801003 | PMID = 18084246 }}</ref> | ||
==IHC== | ==IHC== | ||