Limits...
Bilateral diffuse tumorous pseudoangiomatous stromal hyperplasia: a case of bilateral mastectomy in a 29-year-old woman.

Dai H, Connor C, Cui W, Gatewood J, Fan F - Case Rep Pathol (2014)

Bottom Line: Microscopic evaluation of the nodules confirmed the diagnosis of PASH.No evidence of malignancy was identified.Recognition of this rare form of PASH is essential for the proper clinical management.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

ABSTRACT
Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast lesion commonly encountered as an incidental microscopic finding. However, it can also manifest as a mass-forming lesion (tumorous PASH) capable of recurrence after surgical excision. Most of the previously reported cases of tumorous PASH present as a single dominant mass. Here we reported a rare case of diffuse tumorous PASH involving bilateral breasts clinically mimicking malignancy. A 29-year-old African-American female presented with a one-year history of bilateral breast enlargement and asymmetry. Physical examination revealed multiple palpable nodules in bilateral breasts. Imaging studies demonstrated innumerable homogeneously enhancing masses throughout both breasts, greater on the left, with multiple cysts and edema. Biopsy of the breast nodules demonstrated histopathological changes consistent with PASH. Due to the extent of the lesions and progressive clinical symptoms, decision was made to perform bilateral mastectomy. Macroscopic examination of the bilateral mastectomy specimens revealed markedly enlarged breasts with marked edema and numerous well-defined firm nodules. Microscopic evaluation of the nodules confirmed the diagnosis of PASH. No evidence of malignancy was identified. Recognition of this rare form of PASH is essential for the proper clinical management.

No MeSH data available.


Related in: MedlinePlus

Imaging findings. Contrast enhanced T1 MRI demonstrates innumerable lobulated enhancing masses within both breasts as well as macromastia (a). Sagittal contrast enhanced T1 MRI of the left breast showing macromastia and innumerable lobulated enhancing masses (b).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4269278&req=5

fig1: Imaging findings. Contrast enhanced T1 MRI demonstrates innumerable lobulated enhancing masses within both breasts as well as macromastia (a). Sagittal contrast enhanced T1 MRI of the left breast showing macromastia and innumerable lobulated enhancing masses (b).

Mentions: A previously healthy 29-year-old African-American female presented for evaluation of bilateral progressive breast enlargement, persistent palpable nodules in bilateral breasts, left breast tenderness, left upper extremity pain, and back pain for approximately a year. Previous treatment with antibiotics failed to alleviate symptoms. Physical examination revealed bilateral macromastia, asymmetry, with the left breast being larger than the right, and multiple palpable mammary nodules. Bilateral diagnostic mammograms performed at an outside hospital showed diffuse skin thickening and edema throughout the left breast parenchyma. Left breast sonographic study the same day showed retroareolar ductal prominence with multiple cysts. A skin biopsy was performed by a dermatologist, the result of which was noncontributory. A breast magnetic resonance imaging (MRI) was done at the same outside institution which demonstrated innumerable homogeneously enhancing masses throughout both breasts, greater on the left, with the largest one located on the left measuring up to 3.0 × 2.0 cm. No axillary or internal mammary lymphadenopathy was noted. Differential diagnoses based on imaging studies and clinical presentation included inflammatory breast cancer, severe mastitis, severe fibrocystic changes, and, less likely, phyllodes tumor. The patient reported no family history of breast or ovarian cancer. Two excisional biopsies of the left breast were performed at an outside hospital and were diagnosed as fibroadenoma and lymphangiectasia with associated mild lymphoplasmacytic infiltrate, respectively. The patient was subsequently referred to our institution for further evaluation. The slides of the previous excisional breast biopsies and skin biopsies were obtained and reviewed and were diagnosed as PASH. Sono-guided biopsies of the palpable nodules in the right breast were performed, which revealed fibrosis, duct ectasia, and apocrine metaplasia with no evidence of malignancy. Repeat MRI confirmed the previous findings and demonstrated worsening asymmetry and macromastia (Figure 1). Antihormonal therapy with tamoxifen was recommended; however, the patient declined this treatment option. Due to disease progression, decision was made to perform bilateral mastectomy with immediate reconstruction.


Bilateral diffuse tumorous pseudoangiomatous stromal hyperplasia: a case of bilateral mastectomy in a 29-year-old woman.

Dai H, Connor C, Cui W, Gatewood J, Fan F - Case Rep Pathol (2014)

Imaging findings. Contrast enhanced T1 MRI demonstrates innumerable lobulated enhancing masses within both breasts as well as macromastia (a). Sagittal contrast enhanced T1 MRI of the left breast showing macromastia and innumerable lobulated enhancing masses (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269278&req=5

fig1: Imaging findings. Contrast enhanced T1 MRI demonstrates innumerable lobulated enhancing masses within both breasts as well as macromastia (a). Sagittal contrast enhanced T1 MRI of the left breast showing macromastia and innumerable lobulated enhancing masses (b).
Mentions: A previously healthy 29-year-old African-American female presented for evaluation of bilateral progressive breast enlargement, persistent palpable nodules in bilateral breasts, left breast tenderness, left upper extremity pain, and back pain for approximately a year. Previous treatment with antibiotics failed to alleviate symptoms. Physical examination revealed bilateral macromastia, asymmetry, with the left breast being larger than the right, and multiple palpable mammary nodules. Bilateral diagnostic mammograms performed at an outside hospital showed diffuse skin thickening and edema throughout the left breast parenchyma. Left breast sonographic study the same day showed retroareolar ductal prominence with multiple cysts. A skin biopsy was performed by a dermatologist, the result of which was noncontributory. A breast magnetic resonance imaging (MRI) was done at the same outside institution which demonstrated innumerable homogeneously enhancing masses throughout both breasts, greater on the left, with the largest one located on the left measuring up to 3.0 × 2.0 cm. No axillary or internal mammary lymphadenopathy was noted. Differential diagnoses based on imaging studies and clinical presentation included inflammatory breast cancer, severe mastitis, severe fibrocystic changes, and, less likely, phyllodes tumor. The patient reported no family history of breast or ovarian cancer. Two excisional biopsies of the left breast were performed at an outside hospital and were diagnosed as fibroadenoma and lymphangiectasia with associated mild lymphoplasmacytic infiltrate, respectively. The patient was subsequently referred to our institution for further evaluation. The slides of the previous excisional breast biopsies and skin biopsies were obtained and reviewed and were diagnosed as PASH. Sono-guided biopsies of the palpable nodules in the right breast were performed, which revealed fibrosis, duct ectasia, and apocrine metaplasia with no evidence of malignancy. Repeat MRI confirmed the previous findings and demonstrated worsening asymmetry and macromastia (Figure 1). Antihormonal therapy with tamoxifen was recommended; however, the patient declined this treatment option. Due to disease progression, decision was made to perform bilateral mastectomy with immediate reconstruction.

Bottom Line: Microscopic evaluation of the nodules confirmed the diagnosis of PASH.No evidence of malignancy was identified.Recognition of this rare form of PASH is essential for the proper clinical management.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

ABSTRACT
Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast lesion commonly encountered as an incidental microscopic finding. However, it can also manifest as a mass-forming lesion (tumorous PASH) capable of recurrence after surgical excision. Most of the previously reported cases of tumorous PASH present as a single dominant mass. Here we reported a rare case of diffuse tumorous PASH involving bilateral breasts clinically mimicking malignancy. A 29-year-old African-American female presented with a one-year history of bilateral breast enlargement and asymmetry. Physical examination revealed multiple palpable nodules in bilateral breasts. Imaging studies demonstrated innumerable homogeneously enhancing masses throughout both breasts, greater on the left, with multiple cysts and edema. Biopsy of the breast nodules demonstrated histopathological changes consistent with PASH. Due to the extent of the lesions and progressive clinical symptoms, decision was made to perform bilateral mastectomy. Macroscopic examination of the bilateral mastectomy specimens revealed markedly enlarged breasts with marked edema and numerous well-defined firm nodules. Microscopic evaluation of the nodules confirmed the diagnosis of PASH. No evidence of malignancy was identified. Recognition of this rare form of PASH is essential for the proper clinical management.

No MeSH data available.


Related in: MedlinePlus