title: Aspiration biopsy of nodular pseudoangiomatous stromal hyperplasia of the breast: clinicopathologic correlates in 10 cases.
abstract: Nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast is rare and often indistinguishable from fibroadenoma, clinically and on aspiration biopsy smears. We report our observations in 10 patients with PASH, evaluated by fine-needle aspiration (FNA) biopsy and core biopsy. We retrospectively reviewed the clinical, radiographic, cytologic, and histologic findings in 10 cases of pure nodular PASH. Ten patients with a presumed clinical and radiologic diagnosis of fibroadenoma underwent aspiration biopsy. The aspiration smears were diagnosed as fibroadenoma (4 cases), cellular fibroadenoma (1 case), schwannoma versus neurofibroma (1 case), fibrocystic change (3 cases; 2 with atypia), and "not specific for a lesion" (1 case). A diagnosis of PASH was not suspected in any case. A discrepant or imprecise cytologic diagnosis and/or the presence of dissociated spindle or epithelial cells, or cellular stromal fragments prompted a surgical excision in 7 of 10 patients (70%). The remaining 3 patients exhibited cytologic features of fibroadenoma and were diagnosed as such; however, surgical excision was recommended. Three patients underwent a subsequent core biopsy, with a diagnosis of PASH being made in 1 patient. FNA biopsy could not discriminate PASH from fibroadenoma in 4 of 10 patients (40%) or suggest a diagnosis of PASH in any case. On retrospective review, the finding of plump, spindle-shaped mesenchymal cells may be a cytologic clue to suggest a diagnosis of PASH.
authors.affiliation: Department of Pathology, New York University School of Medicine, New York, New York 10016, USA. pascale.levine@med.nyu.edu
authors.forename: Pascale Hummel
authors.initials: PH
authors.lastname: Levine
authors.forename: Diana
authors.initials: D
authors.lastname: Nimeh
authors.forename: Amber A
authors.initials: AA
authors.lastname: Guth
authors.forename: Joan F
authors.initials: JF
authors.lastname: Cangiarella
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology; D005189:False Positive Reactions; D005260:Female; D018226:Fibroadenoma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies