Difference between revisions of "Pseudoangiomatous stromal hyperplasia"

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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 -ve, CD31 -ve, factor VIII -ve
| Stains    = Bcl-2 +ve, vimentin +ve, CD34 +ve, SMMHC +ve, CD31 -ve, factor VIII -ve
| IHC        =
| IHC        =
| EM        =
| EM        =
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| 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>  
*Often an incidental finding.
*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, abbreviated PASH, is benign lesion is breast pathology.

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

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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