Rapidly growing bilateral pseudoangiomatous stromal hyperplasia of the breast

Abstract

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.

Keywords: Breast; Magnetic resonance (MR); Pseudoangiomatous stromal hyperplasia; Sonography.

Fig. 1

Bilateral pseudoangiomatous stromal hyperplasia of breasts in 47-year-old woman. A. Initial mammography shows huge enlargement of both breasts. Parenchymal pattern is extremely dense. There is reticular density around parenchyma as well as skin thickening. B, C. Sonography of right (B) and left (C) breasts shows skin thickening and low echoes similar to those caused by lobular thickening of glandular layer. Left breast is more prominent than right breast. D-F. Sonography obtained six months after shows substantial progression of glandular layer thickening in patient's left breast. Note presence of conglomerations of tiny cystic spaces (arrows) and abundant color flow indicating hyperemic change. G. Classic features of pseudoangiomatous stromal hyperplasia, i.e., dense, fibrous tissue separates lobular architecture with loose, supporting stroma (Hematoxylin & Eosin staining, ×40). H. Higher magnification view shows cleft lined by endothelial-like, spindle cells in context of stromal hyperplasia (Hematoxylin & Eosin staining, ×200). I. Immunohistochemistry preparation reveals CD 34 reactivity of pseudovascular space lined by myoepithelial cells (Hematoxylin & Eosin staining, ×100). J-L. MRI examination of breast shows high-signal spaces between diffuse and nodular low signals on fat-saturated half-fourier acquisition single-shot turbo spin-echo T2 (J). Entire breast reveals low signal on 2D flash T1. Fibrous hyperplasia with cystic spaces is suggested (K). Low signal on T2 or dense, fibrous tissue shows homogeneous enhancement on fat-saturated T1 after contrast infusion (L). Dynamic study using dedicated coil could not be performed.