Pseudoangiomatous stromal hyperplasia of the breast
a rare condition – from diagnosis to treatment
Keywords:
breast diseases, angiomatosis, hyperplasia, diagnosis, signs and symptoms, therapeuticsAbstract
Pseudoangiomatous Stromal Hyperplasia (PASH) of the breast is a rare condition that consists of the proliferation of the breast myofibroblastic stromal cells, lining anastomosing vascular slit-like spaces. This condition is not considered a pre-malignant lesion and affects mainly premenopausal women. Its etiology is still uncertain, but its behavior points to a hormonal cause. It has a varied clinical presentation and can be diagnosed as an incidental finding of biopsies or with the manifestation of clinical signs and symptoms. As for the diagnosis, it can be performed with the correlation between clinical data, imaging and histopathological analysis. Due to its rare nature, there are still no prospective studies regarding treatment, but, in most cases, clinical and radiological follow-up is a safe strategy. The aim of this paper is to synthesize the data available in the literature about this condition, which, although benign in nature, can bring important aesthetic, musculoskeletal and psychological repercussions.
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References
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Vuitch MF, Rosen PP, Erlandson RA. Pseudoangiomatous hyperplasia of mammary stroma. Hum Pathol. 1986;17(2):185-91. https://doi.org/10.1016/s0046-8177(86)80292-1
Degnim AC, Frost MH, Radisky DC, Anderson SS, Vierkant RA, Boughey JC, et al. Pseudoangiomatous stromal hyperplasia and breast cancer risk. Ann Surg Oncol. 2010;17(12):3269-77. https://doi.org/10.1245/s10434-010-1170-5
Ibrahim RE, Sciotto CG, Weidner N. Pseudoangiomatous hyperplasia of mammary stroma. Some observations regarding its clinicopathologic spectrum. Cancer. 1989;63(6):1154-60. https://doi.org/10.1002/1097-0142(19890315)63:6%3C1154::aid-cncr2820630619%3E3.0.co;2-q
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Yoon KH, Koo B, Lee KB, Lee H, Lee J, Kim JY, et al. Optimal treatment of pseudoangiomatous stromal hyperplasia of the breast. Asian J Surg. 2020;43(7):735-41. https://doi.org/10.1016/j.asjsur.2019.09.008
Silva AE, Serakides R, Cassali GD. Carcinogênese hormonal e neoplasias hormônio-dependentes. Ciência Rural. 2004;34(2):625-33. https://doi.org/10.1590/S0103-84782004000200048
Hargaden GC, Yeh ED, Georgian-Smith D, Moore RH, Rafferty EA, Halpern EF, et al. Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia. AJR Am J Roentgenol. 2008;191(2):359-63. https://doi.org/10.2214/AJR.07.2479
Pruthi S, Reynolds C, Johnson RE, Gisvold JJ. Tamoxifen in the management of pseudoangiomatous stromal hyperplasia. Breast J. 2001;7(6):434-9. https://doi.org/10.1046/j.1524-4741.2001.07611.x
Milanezi MF, Saggioro FP, Zanati SG, Bazan R, Schmitt FC. Pseudoangiomatous hyperplasia of mammary stroma associated with gynaecomastia. J Clin Pathol. 1998;51(3):204-6. https://doi.org/10.1136/jcp.51.3.204
Smilg P. Pseudoangiomatous stromal hyperplasia: presentation and management - a clinical perspective. SA J Radiol. 2018;22(2):a1366. https://doi.org/10.4102/sajr.v22i2.1366
Maciolek LM, Harmon TS, He J, Sadruddin S, Nguyen QD. Pseudoangiomatous stromal hyperplasia of the breast: a rare finding in a male patient. Cureus. 2019;11(6):e4923. https://doi.org/10.7759/cureus.4923
Morone I, de Andrade G, Cardoso P, Oliveira AC, Clímaco F, Medeiros J, et al. Bilateral pseudoangiomatous stromal hyperplasia in childhood gigantomastia: a challenge in reconstruction and management. JPRAS Open. 2019;19:106-10. https://doi.org/10.1016/j.jpra.2018.08.003
Jonckheere J, Vanhoeij M, Garkalne I, Antic M, Schiettecatte A, de Mey J. A rare cause of unilateral breast swelling in a male infant caused by fibrous hamartoma of infancy combined with pseudoangiomatous stromal hyperplasia. Radiol Case Rep. 2019;15(3):234-6. https://doi.org/10.1016/j.radcr.2019.11.015
Rafeek N, Dev B, Thambidurai L, Satchidanandam A. Tumoral pseudoangiomatous stromal hyperplasia: radiological and pathological correlation with review of literature. Egypt J Radiol Nucl Med. 2017;48(1):147-52. https://doi.org/10.1016/j.ejrnm.2016.10.008
Kelten Talu C, Boyaci C, Leblebici C, Hacihasanoglu E, Bozkurt ER. Pseudoangiomatous Stromal Hyperplasia in Core Needle Biopsies of Breast Specimens. Int J Surg Pathol. 2017;25(1):26-30. https://doi.org/10.1177/1066896916660763
Surace A, Liberale V, D’Alonzo M, Pecchio S, Baù MG, Biglia N. Pseudoangiomatous stromal hyperplasia (PASH) of the breast: an uncommon finding in an uncommon patient. Am J Case Rep. 2020;21:e919856. https://doi.org/10.12659/AJCR.919856
Yoon KH, Koo B, Lee KB, Lee H, Lee J, Kim JY, et al. Optimal treatment of pseudoangiomatous stromal hyperplasia of the breast. Asian J Surg. 2020;43(7):735-41. https://doi.org/10.1016/j.asjsur.2019.09.008
Silva AE, Serakides R, Cassali GD. Carcinogênese hormonal e neoplasias hormônio-dependentes. Ciência Rural. 2004;34(2):625-33. https://doi.org/10.1590/S0103-84782004000200048
Hargaden GC, Yeh ED, Georgian-Smith D, Moore RH, Rafferty EA, Halpern EF, et al. Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia. AJR Am J Roentgenol. 2008;191(2):359-63. https://doi.org/10.2214/AJR.07.2479
Pruthi S, Reynolds C, Johnson RE, Gisvold JJ. Tamoxifen in the management of pseudoangiomatous stromal hyperplasia. Breast J. 2001;7(6):434-9. https://doi.org/10.1046/j.1524-4741.2001.07611.x
Milanezi MF, Saggioro FP, Zanati SG, Bazan R, Schmitt FC. Pseudoangiomatous hyperplasia of mammary stroma associated with gynaecomastia. J Clin Pathol. 1998;51(3):204-6. https://doi.org/10.1136/jcp.51.3.204
Smilg P. Pseudoangiomatous stromal hyperplasia: presentation and management - a clinical perspective. SA J Radiol. 2018;22(2):a1366. https://doi.org/10.4102/sajr.v22i2.1366
Maciolek LM, Harmon TS, He J, Sadruddin S, Nguyen QD. Pseudoangiomatous stromal hyperplasia of the breast: a rare finding in a male patient. Cureus. 2019;11(6):e4923. https://doi.org/10.7759/cureus.4923
Morone I, de Andrade G, Cardoso P, Oliveira AC, Clímaco F, Medeiros J, et al. Bilateral pseudoangiomatous stromal hyperplasia in childhood gigantomastia: a challenge in reconstruction and management. JPRAS Open. 2019;19:106-10. https://doi.org/10.1016/j.jpra.2018.08.003
Jonckheere J, Vanhoeij M, Garkalne I, Antic M, Schiettecatte A, de Mey J. A rare cause of unilateral breast swelling in a male infant caused by fibrous hamartoma of infancy combined with pseudoangiomatous stromal hyperplasia. Radiol Case Rep. 2019;15(3):234-6. https://doi.org/10.1016/j.radcr.2019.11.015
Rafeek N, Dev B, Thambidurai L, Satchidanandam A. Tumoral pseudoangiomatous stromal hyperplasia: radiological and pathological correlation with review of literature. Egypt J Radiol Nucl Med. 2017;48(1):147-52. https://doi.org/10.1016/j.ejrnm.2016.10.008
Kelten Talu C, Boyaci C, Leblebici C, Hacihasanoglu E, Bozkurt ER. Pseudoangiomatous Stromal Hyperplasia in Core Needle Biopsies of Breast Specimens. Int J Surg Pathol. 2017;25(1):26-30. https://doi.org/10.1177/1066896916660763
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Copyright (c) 2021 Julimar Rocha de Assis, Cristiana Buzelin Nunes, Clécio Ênio Murta de Lucena
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