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 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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