Pseudoangiomatous Stromal Hyperplasia in Mammary Lesions

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative condition of the breast characterised by an overgrowth of fibrous stromal tissue forming anastomosing, slit-like spaces that mimic vascular channels. Although often an incidental microscopic finding, PASH can present as a palpable mass or diffuse enlargement, occasionally reaching gigantomastia in hormonally sensitive individuals. Imaging features on mammography and ultrasound are non-specific, frequently resembling fibroadenoma or phyllodes tumour, which underlines the importance of histopathological assessment. Immunohistochemical studies typically demonstrate myofibroblastic proliferation without true endothelial lining. Management ranges from conservative observation for small, asymptomatic lesions to surgical excision for larger, rapidly growing masses or when malignancy cannot be excluded. Recurrence is uncommon after complete removal but may occur in cases with incomplete excision or extensive disease. Ongoing research explores hormonal influences, optimal imaging protocols and long-term outcomes to guide clinical decision-making and avoid overtreatment.

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Pseudoangiomatous Stromal Hyperplasia in Mammary Lesions publication trend

The graph below shows the total number of articles in pseudoangiomatous stromal hyperplasia in mammary lesions across all publications each year (not limited to Nature Index journals).

Technical terms

Pseudoangiomatous stromal hyperplasia (PASH): A benign proliferation of myofibroblastic stroma in the breast forming slit-like spaces that resemble blood vessels.

Stroma: The connective tissue framework of the breast, containing fibroblasts, myofibroblasts and extracellular matrix.

Gigantomastia: Excessive and rapid breast enlargement often driven by hormonal stimulation.

Core needle biopsy: A percutaneous technique to obtain cylindrical tissue samples for histological diagnosis.

References

1. Pseudoangiomatous stromal hyperplasia: Presentation and management – a clinical perspective. South African Journal of Radiology (2018).
2. Gestational Pseudoangiomatous Stromal Hyperplasia Presenting as Gigantomastia: A Case Report of a Rare Breast Entity with Clinical Recommendations by a Multidisciplinary Team. Case Reports in Surgery (2023).
3. A case report and a literature review of double mammary pseudoangiomatous stromal hyperplasia associated with galactoma during pregnancy. Frontiers in Oncology (2024).
4. Pseudoangiomatous stromal hyperplasia (PASH) of the breast: A case series. Updates in Surgery (2024).