Bilateral multicenter pseudohemangiomatous interstitial hyperplasia of the breast: a case report

Abstract

Bilateral multicenter breast pseudohemangiomatous stromal hyperplasia (PASH) is a rare, benign breast disease. Here, we report on a female patient with bilateral multicenter PASH who underwent a mastectomy and prosthetic reconstruction. The surgery was successful, and no recurrence was observed during the 18 months of follow up.

Keywords: Pseudohemangiomatous interstitial hyperplasia; breast reconstruction; case report; mammary gland.

Figure 1.

PASH patient before surgery. (A – C) Pre-surgery photographs taken from different angles, indicating breast asymmetry. The right breast was significantly larger than the left, and mild venous dilatation can be observed on the surface of both breasts. PASH, Pseudoangiomatous stromal hyperplasia.

Figure 2.

Preoperative color ultrasonography (A, B), mammography (C, D), and MRI (E, F) of bilateral breasts. Color ultrasonography (A, B) of the breast indicated a solid mass with a clear boundary, a low blood flow signal (A), and cystic changes. Mammography (C, D) indicated dense and lamellar bodies of both mammary glands, with no obvious nodular sensation, bilateral axillary lymph node shadows, and a few coarse calcifications in the right mammary gland. MRI (E, F) indicated dense glands in both breasts, with multiple mixed long T1 (E) and long T2 (F2) abnormal signal shadows in each quadrant. MRI, Magnetic resonance imaging.

Figure 3.

The gross specimen of the left breast excised during the surgery. Multiple tumors of different sizes can be observed (A). When the tumors were cut open, their surface was gray and fresh (B).

Figure 4.

Postoperative pathology of the breast. Microscopically, the mammary stromal cells proliferated and formed overlapping fissures. Spindle cells were attached, they were mild in shape, with no obvious atypia, and no mitotic image of the nucleus was found (A, hematoxylin and eosin (H&E) staining, ×400). Immunohistochemistry (IHC): Interstitial cells were positive for CD34 staining (Figure E, streptavidin-perosidase (SP) conjugated method, ×400) and negative for CD31 staining (Figure F, streptavidin-perosidase (SP) conjugated method, ×400). CD34 was expressed in the cytoplasm (shown in brown), and the nucleus is shown in blue. However, the vascular endothelial cells were positive for CD31 staining, which is expressed in the cytoplasm, shown in brown (red-circled areas in B and C). IHC, Immunohistochemistry.

Figure 5.

Follow-up 18 months after the operation. There is no tumor recurrence, the reconstructed breast was symmetrical, and the shape was excellent. (A–C) Post-surgery photographs taken from different angles.