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Geburtshilfe Frauenheilkd 2015; 75(2): 183-187
DOI: 10.1055/s-0034-1383418
Case Report
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Multifocal Tumorous Pseudoangiomatous Stromal Hyperplasia Presenting as Asymmetric Bilateral Breast Enlargement

Multifokale tumoröse pseudoangiomatöse Stromahyperplasie mit bilateraler asymmetrischer Makromastie
I. Vasconcelos
1   Senologie Praxis am Kurfürstendamm, Berlin
,
C. M. Perez Fernandez
2   Radiology, Charité, Berlin
,
S. Günzel
3   Gemeinschaftspraxis Pathologie am Martin-Luther-Krankenhaus, Berlin
,
W. Schoenegg
1   Senologie Praxis am Kurfürstendamm, Berlin
› Author Affiliations
Further Information

Publication History

received 03 August 2014
revised 06 December 2014

accepted 06 December 2014

Publication Date:
16 March 2015 (online)

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Abstract

PASH is a benign proliferation of stromal myofibroblasts that affects mostly premenopausal women and typically shows estrogen and progesterone receptor expression, allowing speculation regarding a hormonal cause. It usually presents as an incidental finding on a mammogram or as a palpable mass. We present a case of diffuse asymmetrical massive breast enlargement in a premenopausal woman with history of previous multiple PASH excisions for recurrent lesions, caused by multifocal tumorous PASH virtually replacing the breast parenchyma. Immunohistochemistry examination showed no hormone receptor expression. Despite its benign nature, such presentation of PASH is managed with bilateral mastectomy and immediate reconstruction with expanders for cosmetic and comfort reasons, while tumor excision or expectant management is deemed to lead to recurrence and progression. Although a hormonal origin is speculated based on hormone expression studies and typical patient profile, this case showed 0 % estrogen/progesterone expression in the final histology specimen.

Zusammenfassung

PASH ist eine gutartige Proliferation der stromalen Myofibroblasten. Betroffen sind überwiegend prämenopausale Frauen. Die typischerweise vorliegende Estrogen-/Progesteron-Rezeptorexpression legt die Vermutung einer hormonellen Ursache nahe. Häufig zeigt sich die PASH zufällig in der Mammografie oder als tastbarer Herd in der Mamma. Wir stellen den Fall einer massiven asymmetrischen Makromastie bei einer prämenopausalen Frau vor, die anamnestisch mehrere vorangegangene Tumorektomien wegen rezidivierenden PASH–Herden hatte. Nahezu das gesamte Brustdrüsenparenchym wurde durch die multifokalen tumorösen PASH-Herde ersetzt. Ungeachtet der Gutartigkeit der Herde wurde bei der Patientin eine bilaterale Mastektomie mit Sofortrekonstruktion mit Implantaten aus kosmetischen Gründen durchgeführt, da ein abwartendes Verhalten zu einer weiteren Progression geführt hätte. Trotz der Vermutung einer hormonellen Ursache der PASH zeigte unser Fall keine Hormonrezeptorexpression.

Key words

benign mammary gland tumor - hormonal receptor - breast

Schlüsselwörter

Mamma - benigne Mammatumoren - Hormonrezeptor
 

  • References

  • 1 Bostwick III J. Plastic and reconstructive Breast Surgery. St Louis: Quality Medical Publishing Inc.; 1990
    Google Scholar
  • 2 Vuitch MF, Rosen PP, Erlandson RA. Pseudoangiomatous hyperplasia of mammary stroma. Hum Pathol 1986; 17: 185-191
    CrossrefPubMedGoogle Scholar
  • 3 Ibrahim RE, Sciotto CG, Weidner N. Pseudoangiomatous hyperplasia of mammary stroma. Some observations regarding its clinicopathologic spectrum. Cancer 1989; 63: 1154-1160
    CrossrefPubMedGoogle Scholar
  • 4 Gresik CM, Godellas C, Aranha GV et al. Pseudoangiomatous stromal hyperplasia of the breast: a contemporary approach to its clinical and radiologic features and ideal management. Surgery 2010; 148: 752-757 discussion 757–758
    CrossrefPubMedGoogle Scholar
  • 5 Drinka EK, Bargaje A, Erşahin ÇH et al. Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a clinicopathological study of 79 cases. Int J Surg Pathol 2012; 20: 54-58
    CrossrefPubMedGoogle Scholar
  • 6 Ferreira M, Albarracin CT, Resetkova E. Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases. Mod Pathol 2008; 21: 201-207
    PubMedGoogle Scholar
  • 7 Jones KN, Glazebrook KN, Reynolds C. Pseudoangiomatous stromal hyperplasia: imaging findings with pathologic and clinical correlation. AJR Am J Roentgenol 2010; 195: 1036-1042
    CrossrefPubMedGoogle Scholar
  • 8 Bowman E, Oprea G, Okoli J et al. Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a series of 24 patients. Breast J 2012; 18: 242-247
    CrossrefPubMedGoogle Scholar
  • 9 Powell CM, Cranor ML, Rosen PP. Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation. Am J Surg Pathol 1995; 19: 270-277
    CrossrefPubMedGoogle Scholar
  • 10 Ryu EM, Whang IY, Chang ED. Rapidly growing bilateral pseudoangiomatous stromal hyperplasia of the breast. Korean J Radiol 2010; 11: 355-358
    CrossrefPubMedGoogle Scholar
  • 11 Yoo K, Woo OH, Yong HS et al. Fast-growing pseudoangiomatous stromal hyperplasia of the breast: report of a case. Surg Today 2007; 37: 967-970
    CrossrefPubMedGoogle Scholar
  • 12 Lee JS, Oh HS, Min KW. Mammary pseudoangiomatous stromal hyperplasia presenting as an axillary mass. Breast 2005; 14: 61-64
    CrossrefPubMedGoogle Scholar
  • 13 Iancu D, Nochomovitz LE. Pseudoangiomatous stromal hyperplasia: presentation as a mass in the female nipple. Breast J 2001; 7: 263-265
    CrossrefPubMedGoogle Scholar
  • 14 Mercado CL, Naidrich SA, Hamele-Bena D et al. Pseudoangiomatous stromal hyperplasia of the breast: sonographic features with histopathologic correlation. Breast J 2004; 10: 427-432
    CrossrefPubMedGoogle Scholar
  • 15 Wieman SM, Landercasper J, Johnson JM et al. Tumoral pseudoangiomatous stromal hyperplasia of the breast. Am Surg 2008; 74: 1211-1214
    PubMedGoogle Scholar
  • 16 Teh HS, Chiang SH, Leung JW et al. Rapidly enlarging tumoral pseudoangiomatous stromal hyperplasia in a 15-year-old patient: distinguishing sonographic and magnetic resonance imaging findings and correlation with histologic findings. J Ultrasound Med 2007; 26: 1101-1106
    PubMedGoogle Scholar
  • 17 Bolla D, Wiedemann N, Ohlschlegel C et al. Pseudoangiomatous stromal hyperplasia of breast in man: a case report. Breast J 2011; 17: 311-312
    CrossrefPubMedGoogle Scholar
  • 18 Milanezi MF, Saggioro FP, Zanati SG et al. Pseudoangiomatous hyperplasia of mammary stroma associated with gynaecomastia. J Clin Pathol 1998; 51: 204-206
    CrossrefPubMedGoogle Scholar
  • 19 Levine PH, Nimeh D, Guth AA et al. Aspiration biopsy of nodular pseudoangiomatous stromal hyperplasia of the breast: clinicopathologic correlates in 10 cases. Diagn Cytopathol 2005; 32: 345-350
    CrossrefPubMedGoogle Scholar
  • 20 Vicandi B, Jimenez-Heffernan JA, Lopez-Ferrer P et al. Nodular pseudoangiomatous stromal hyperplasia of the breast. Cytologic features. Acta Cytol 1998; 42: 335-341
    CrossrefPubMedGoogle Scholar
  • 21 Tse GM, Tan PH, Lui PC et al. Spindle cell lesions of the breast–the pathologic differential diagnosis. Breast Cancer Res Treat 2008; 109: 199-207
    CrossrefPubMedGoogle Scholar
  • 22 Sasaki Y, Kamata S, Saito K et al. Pseudoangiomatous stromal hyperplasia (PASH) of the mammary gland: report of a case. Surg Today 2008; 38: 340-343
    CrossrefPubMedGoogle Scholar
  • 23 Zanella M, Falconieri G, Lamovec J et al. Pseudoangiomatous hyperplasia of the mammary stroma: true entity or phenotype?. Pathol Res Pract 1998; 194: 535-540
    CrossrefPubMedGoogle Scholar
  • 24 Anderson C, Ricci jr. A, Pedersen CA et al. Immunocytochemical analysis of estrogen and progesterone receptors in benign stromal lesions of the breast. Evidence for hormonal etiology in pseudoangiomatous hyperplasia of mammary stroma. Am J Surg Pathol 1991; 15: 145-149
    CrossrefPubMedGoogle Scholar
  • 25 Miettinen M, Wang ZF, Paetau A et al. ERG transcription factor as an immunohistochemical marker for vascular endothelial tumors and prostatic carcinoma. Am J Surg Pathol 2011; 35: 432-441
    CrossrefPubMedGoogle Scholar
  • 26 Comunoglu N, Comunoglu C, Ilvan S et al. Mammary pseudoangiomatous stromal hyperplasia composed of predominantly giant cells: an unusual variant. Breast J 2007; 13: 568-570
    CrossrefPubMedGoogle Scholar
  • 27 Hanna W, AL-Maghrabi J, Malik A. Aggressive giant fibroepithelial lesion with unusual vascular stroma–a case report. Mod Pathol 2003; 16: 823-827
    CrossrefPubMedGoogle Scholar
  • 28 Lerwill MF. Biphasic lesions of the breast. Semin Diagn Pathol 2004; 21: 48-56
    CrossrefPubMedGoogle Scholar
  • 29 Degnim AC, Frost MH, Radisky DC et al. Pseudoangiomatous stromal hyperplasia and breast cancer risk. Ann Surg Oncol 2010; 17: 3269-3277
    CrossrefPubMedGoogle Scholar
  • 30 Tan PH, Jayabaskar T, Chuah KL et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol 2005; 123: 529-540
    CrossrefPubMedGoogle Scholar
  • 31 Pruthi S, Reynolds C, Johnson RE et al. Tamoxifen in the management of pseudoangiomatous stromal hyperplasia. Breast J 2001; 7: 434-439
    CrossrefPubMedGoogle Scholar