title: Tumoral pseudoangiomatous stromal hyperplasia of the breast.
abstract: Tumoral pseudoangiomatous stromal hyperplasia (PASH) is a rare benign proliferative disease of the breast. The majority of the literature reports of PASH have not contained detailed descriptions of the imaging characteristics of PASH. A 10-year retrospective study of patients with tumoral PASH and a 20-year Ovid MEDLINE search were performed to determine whether specific imaging and needle biopsy results could characterize PASH preoperatively. We identified 22 patients with tumoral PASH. Seventeen (77%) of 22 women had a palpable lump and 14 (72%) of 21 had a density on mammography. Ultrasound (US) findings included mixed or hypoechoic echogenicity in 83 per cent and ill-defined borders in 62 per cent. Eight (36%) patients had lesions with a Breast Imaging Reporting and Data System (BI-RADS) classification of 4 or 5. The sensitivity of preoperative core needle biopsy (CNB) to identify PASH was 83 per cent. A review of the literature revealed that 90 per cent of patients with PASH had some malignant imaging characteristics and 95 per cent had a mass on mammography. The imaging characteristics of PASH exhibited marked variability. Excision of PASH after CNB may be considered for patients with symptoms, enlarging lesions, or lesions classified as BI-RADS 4 or 5. PASH diagnosed by CNB allows selected patients to avoid excision.
authors.affiliation: Department of General Surgery, Norma J. Vinger Center for Breast Care (NJVCBV), the Gundersen Lutheran Health System, La Crosse, Wisconsin 54601, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Wieman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Landercasper
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Johnson
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ellis
authors.forename: Susan M
authors.initials: SM
authors.lastname: Wester
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Lambert
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000798:Angiomatosis / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001941:Breast Diseases / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D017154:Stromal Cells / Q000473:pathology*; D016217:Ultrasonography, Mammary