Difference between revisions of "Pseudoangiomatous stromal hyperplasia"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Pseudoangiomatous_stromal_hyperplasia_-_high_mag.jpg
| Width      =
| Caption    = Pseudoangiomatous stromal hyperplasia. [[H&E stain]].
| Synonyms  =
| Micro      = abundant breast stroma, small complex inter-anastomosing (blood vessel/capillary-like) channels
| Subtypes  =
| LMDDx      = [[fibroadenoma]], low-grade [[angiosarcoma]]
| Stains    = Bcl-2 +ve, vimentin +ve, CD34 +ve, SMMHC +ve, CD31 -ve, factor VIII -ve
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[breast]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = +/-breast mass
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = [[fibroadenoma]]
| 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: grey-white & firm, with well circumscribed borders.
*May form mass.
**Grey-white & firm.
**Well-circumscribed borders.


==Microscopic==
==Microscopic==
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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:
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===Images===
===Images===
<gallery>
<gallery>
Image:Pseudoangiomatous_stromal_hyperplasia_-a-_low_mag.jpg | PASH - low mag. (WC/Nephron)
Image:Pseudoangiomatous stromal hyperplasia -a- low mag.jpg | PASH - low mag. (WC/Nephron)
Image:Pseudoangiomatous_stromal_hyperplasia_-a-_intermed_mag.jpg | PASH - intermed. mag. (WC/Nephron)
Image:Pseudoangiomatous stromal hyperplasia -a- intermed mag.jpg | PASH - intermed. mag. (WC/Nephron)
Image:Pseudoangiomatous_stromal_hyperplasia_-_high_mag.jpg | PASH - high mag. (WC/Nephron)
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:
*[http://www.nature.com/modpathol/journal/v21/n2/fig_tab/3801003f1.html#figure-title 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>
*[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==

Latest revision as of 22:22, 2 April 2019

Pseudoangiomatous stromal hyperplasia
Diagnosis in short

Pseudoangiomatous stromal hyperplasia. H&E stain.
LM abundant breast stroma, small complex inter-anastomosing (blood vessel/capillary-like) channels
LM DDx fibroadenoma, low-grade angiosarcoma
Stains Bcl-2 +ve, vimentin +ve, CD34 +ve, SMMHC +ve, CD31 -ve, factor VIII -ve
Site breast
Signs +/-breast mass
Prevalence uncommon
Prognosis benign
Clin. DDx fibroadenoma
Treatment followup or excision

Pseudoangiomatous stromal hyperplasia, abbreviated PASH, is benign lesion is breast pathology.

It is also known as nodular myofibroblastic stromal hyperplasia of the mammary gland.[1]

General

  • Benign lesion.
  • Thought to arise due to myofibroblast abnormality - though not well understood.[2]
  • An incidental finding or occasionally a mass.[3]
  • May be suspicious on imaging (BI-RADS 4 or 5).[4]
  • May be followed (expectant management) or (surgically) excised.[5]

Gross

Features:[2]

  • May form mass.
    • Grey-white & firm.
    • Well-circumscribed borders.

Microscopic

Features:[6][7]

  • Abundant breast stromal.
  • Small, complex, inter-anastomosing (blood vessel/capillary-like) channels - key feature.
    • Pseudoangiomatous = blood vessel-like.

Notes:

  • May mimic angiosarcoma at low power; PASH may have the same architecture but lack nuclear atypia.
  • Occasionally has mitotic activity - proliferative PASH.

DDx:

Images

  • PASH - low mag. (WC/Nephron)

  • PASH - intermed. mag. (WC/Nephron)

  • PASH - intermed. mag. (WC/Nephron)

  • PASH - high mag. (WC/Nephron)

  • PASH - intermed. mag. (WC/Nephron)

  • PASH - high mag. (WC/Nephron)

  • PASH - very high mag. (WC/Nephron)

www:

IHC

Findings:[2]

  • CD34 +ve.
  • Vimentin +ve.
  • Bcl-2 +ve.[8][9]
  • Factor VIII -ve.
  • CD31 -ve.[8]

See also

References

  1. ↑ Leon, ME.; Leon, MA.; Ahuja, J.; Garcia, FU.. "Nodular myofibroblastic stromal hyperplasia of the mammary gland as an accurate name for pseudoangiomatous stromal hyperplasia of the mammary gland.". Breast J 8 (5): 290-3. PMID 12199757.
  2. ↑ 2.0 2.1 2.2 Powell CM, Cranor ML, Rosen PP (March 1995). "Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation". Am. J. Surg. Pathol. 19 (3): 270–7. PMID 7872425.
  3. ↑ Drinka, EK.; Bargaje, A.; Erşahin, ÇH.; Patel, P.; Salhadar, A.; Sinacore, J.; Rajan, P. (Feb 2012). "Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a clinicopathological study of 79 cases.". Int J Surg Pathol 20 (1): 54-8. doi:10.1177/1066896911418643. PMID 21862488.
  4. ↑ Wieman, SM.; Landercasper, J.; Johnson, JM.; Ellis, RL.; Wester, SM.; Lambert, PJ.; Ross, LA. (Dec 2008). "Tumoral pseudoangiomatous stromal hyperplasia of the breast.". Am Surg 74 (12): 1211-4. PMID 19097540.
  5. ↑ Jaunoo, SS.; Thrush, S.; Dunn, P. (2011). "Pseudoangiomatous stromal hyperplasia (PASH): a brief review.". Int J Surg 9 (1): 20-2. doi:10.1016/j.ijsu.2010.09.005. PMID 20887819.
  6. ↑ Vuitch MF, Rosen PP, Erlandson RA (February 1986). "Pseudoangiomatous hyperplasia of mammary stroma". Hum. Pathol. 17 (2): 185–91. PMID 3949338.
  7. ↑ 7.0 7.1 Ferreira, M.; Albarracin, CT.; Resetkova, E. (Feb 2008). "Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases.". Mod Pathol 21 (2): 201-7. doi:10.1038/modpathol.3801003. PMID 18084246.
  8. ↑ 8.0 8.1 Baker, M.; Chen, H.; Latchaw, L.; Memoli, V.; Ornvold, K. (Aug 2011). "Pseudoangiomatous stromal hyperplasia of the breast in a 10-year-old girl.". J Pediatr Surg 46 (8): e27-31. doi:10.1016/j.jpedsurg.2011.04.063. PMID 21843705.
  9. ↑ URL: http://surgpathcriteria.stanford.edu/breast/pash/printable.html. Accessed on: 28 April 2012.
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