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Tumorous PASH Presenting as Rapid Unilateral Breast Enlargement

      A 36-year-old woman presented with a 3-month history of progressive, rapid enlargement of the right breast. She had no family history of breast diseases and had not been taking any medications. On examination, the right breast was dramatically enlarged when compared with the left (Figure 1). We obtained a bilateral diagnostic mammogram, ultrasonography, core biopsies (Figure 2, A), and magnetic resonance imaging (Figure 2, B) of the right breast. Pathologic examination revealed pseudoangiomatous stromal hyperplasia (PASH), with no evidence of malignancy.
      Figure thumbnail gr1
      Figure 1Large oval, well-circumscribed fibrous tumor of right breast.
      Figure thumbnail gr2
      Figure 2A, Benign proliferative glands surrounded by stroma containing slit-like spaces simulating vessels. Magnification, 100×. B, Magnetic resonance image shows a mass occupying nearly the entire right breast.
      The patient underwent a bilateral mastectomy with immediate breast reconstruction, and the tumor resected from the right breast measured 11.0 × 8.5 × 6.0 cm and weighed 666.0 g. The final pathologic findings were consistent with tumorous PASH.
      • Vuitch M.F.
      • Rosen P.P.
      • Erlandson R.A.
      Pseudoangiomatous hyperplasia of mammary stroma.
      This is among the largest PASH tumors reported in the medical literature. The patient had an excellent clinical and cosmetic outcome.
      An incidental finding of microscopic PASH in breast biopsy specimens is not uncommon.
      • Ibrahim R.E.
      • Sciotto C.G.
      • Weidner N.
      Pseudoangiomatous hyperplasia of mammary stroma: some observations regarding its clinicopathologic spectrum.
      • Virk R.K.
      • Khan A.
      Pseudoangiomatous stromal hyperplasia: an overview.
      However, PASH presenting as a dominant palpable mass, the so-called tumorous PASH, is rare, with only a handful of case series recently reported. Most cases present as slow-growing masses and are resected before any major distortion of the breast architecture occurs.
      • Virk R.K.
      • Khan A.
      Pseudoangiomatous stromal hyperplasia: an overview.
      PASH presenting as diffuse unilateral breast enlargement is an extremely rare finding.
      The most striking feature of this case is not only the tremendous size to which the tumor grew but also the short time interval for such growth. The patient had good access to care, but a disfiguring tumor developed in a very short time.

      References

        • Vuitch M.F.
        • Rosen P.P.
        • Erlandson R.A.
        Pseudoangiomatous hyperplasia of mammary stroma.
        Hum Pathol. 1986; 17: 185-191
        • Ibrahim R.E.
        • Sciotto C.G.
        • Weidner N.
        Pseudoangiomatous hyperplasia of mammary stroma: some observations regarding its clinicopathologic spectrum.
        Cancer. 1989; 63: 1154-1160
        • Virk R.K.
        • Khan A.
        Pseudoangiomatous stromal hyperplasia: an overview.
        Arch Pathol Lab Med. 2010; 134: 1070-1074