Pseudoangiomatous stromal hyperplasia

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

Pseudoangiomatous stromal hyperplasia
Diagnosis in short

Pseudoangiomatous stromal hyperplasia. H&E stain.
LM DDx fibroadenoma, low-grade angiosarcoma
Stains Bcl-2 +ve, vimentin +ve, CD34 -ve, CD31 -ve, factor VIII -ve
Site breast
Signs +/-breast mass
Prevalence uncommon
Prognosis benign
Clin. DDx fibroadenoma
Treatment excision

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]
  • Often an incidental finding.

Gross

Features:[2]

  • May form mass: grey-white & firm, with well circumscribed borders.

Microscopic

Features:[3][4]

  • 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.

DDx:

Images

  • PASH - low mag. (WC/Nephron)

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

  • PASH - high mag. (WC/Nephron)

www:

IHC

Findings:[2]

  • CD34 +ve.
  • Vimentin +ve.
  • Bcl-2 +ve.[5][6]
  • Factor VIII -ve.
  • CD31 -ve.[5]

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. ↑ Vuitch MF, Rosen PP, Erlandson RA (February 1986). "Pseudoangiomatous hyperplasia of mammary stroma". Hum. Pathol. 17 (2): 185–91. PMID 3949338.
  4. ↑ 4.0 4.1 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.
  5. ↑ 5.0 5.1 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.
  6. ↑ URL: http://surgpathcriteria.stanford.edu/breast/pash/printable.html. Accessed on: 28 April 2012.
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