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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 573-574
Tumoral pseudoangiomatous stromal hyperplasia of the breast: A rare entity

1 Department of Pathology and Plastic Surgery, Satguru Pratap Singh Apollo Hospitals, Ludhiana, Punjab, India
2 Department of Cosmetic Surgery, Satguru Pratap Singh Apollo Hospitals, Ludhiana, Punjab, India

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Date of Web Publication22-Oct-2010

How to cite this article:
Goyal R, Abrol A. Tumoral pseudoangiomatous stromal hyperplasia of the breast: A rare entity. Indian J Pathol Microbiol 2010;53:573-4

How to cite this URL:
Goyal R, Abrol A. Tumoral pseudoangiomatous stromal hyperplasia of the breast: A rare entity. Indian J Pathol Microbiol [serial online] 2010 [cited 2022 Jul 5];53:573-4. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/573/68248


This is with reference to the article by Aron M, Ray R, Verma K

''Pseudoangiomatous stromal hyperplasia of the breast - cytological features of two cases and review of literature,'' published in Indian Journal of Pathology and Microbiology.[1] We share our case, which was similar to the published report.

A 26-year-old female presented with a lump of one year duration in the right breast. There was no history of local pain or nipple discharge. The past and family history was not significant. The clinical impression was fibro adenoma. Fine needle aspiration cytology (FNAC) examination done elsewhere reported it as benign breast lesion.

Excision biopsy of the lump was performed and the lump was subjected to histopathological examination. Grossly, it was a circumscribed unencapsulated lump measuring 5.0 Χ 3.6 Χ 2.0 cm. Cut surface was uniform, gray white, without any necrosis or hemorrhage [Figure 1]. Microscopically, there were anatomizing empty slit like spaces present within and between the lobules with a perilobular concentric arrangement. These spaces were lined by flattened spindle shaped cells. There was mild increase in the prominence of the intralobular specialized stroma. Mitosis, pleomorphism or atypia were absent [Figure 2]a-c. There was no necrosis, or destruction of normal breast tissue. Immunohistochemistry carried out revealed strong cytoplasmic positivity in spindle cells for vimentin as well as smooth muscle actin (SMA) [Figure 2]d.
Figure 1: Gross photograph of the breast lump showing homogenous cut surface without any necrosis or hemorrhage

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Figure 2: (a) Photomicrograph showing empty slit like spaces within and between the lobules, characteristi c of pseudoangiomatous stromal hyperplasia (H and E, ×100), (b),(c) Photomicrograph emphasizing the
slit like spaces lined by spindle cells (H and E, ×200), (d) Photomicrograph showing positi vity of spindle cells for SMA immunostain (IHC, ×200)

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Based on the characteristic morphological findings, the diagnosis of tumoral pseudoangiomatous stromal hyperplasia (PASH) was made.

PASH was originally reported by Vuitch et al.[2] It is characterized by small empty slit like spaces bordered by flattened bland spindle cells. The spindle cells demonstrate evidence of myofibroblastic differentiation and do not express endothelial markers. [3,4] The slit like spaces are sometimes inconspicuous with the spindle cells forming thin, linear cords. The surrounding collagen tends to be brightly eosinophilic and organized in short wavy bundles. [3] Within the stromal proliferation are mildly dilated and evenly dispersed glands. Intact, compact terminal duct lobular units are usually not prominent; instead the glands are often spread apart by the stromal hyperplasia. [3] PASH represents a clinic-pathological spectrum ranging from focal, incidental findings to clinically and mammographically evident breast mass. [5]

The tumoral form of PASH most commonly manifests as a single, circumscribed, palpable mass in a premenopausal female. [4] The spindle cells in PASH are immunoreactive for vimentin, CD34, and negative for FVIII related antigen, Ulex and CD31. In addition, they show intense positivity for progesterone receptors. The latter finding suggests that PASH represents a localized form of stromal overgrowth with a hormonal (primarily progestogenic) pathogenesis.

The rarity of tumoral PASH contributes to the difficulty in its diagnosis. Imaging may be a helpful diagnostic aid. These lesions have radiologic features similar to those of fibro adenoma. FNAC examination has been found to be nonspecific and the role of FNAC in PASH is to confirm the benign nature of the lesion rather than to provide a definitive pre-surgical diagnosis. Histological diagnosis is necessary for a confirmatory diagnosis. Although mass lesions in PASH often grow over time and may recur after excisional biopsy, they are neither associated with malignancy nor considered to be premalignant lesions. The prognosis is good, with a reported low recurrence rate of approximately 10%. [2],[4] Close imaging follow-up is recommended to assess for interval growth or recurrence. In our patient, there was no recurrence after eight months of follow-up.

   References Top

1.Aron M, Ray R, Verma K. Pseudoangiomatous stromal hyperplasia of the breast - cytological features of two cases and review of literature. Indian J Pathol Microbiol 2005;48:260-4.  Back to cited text no. 1      
2.Vuitch MF, Rosen PP, Erlandson RA. Pseudoangiomatous hyperplasia of mammary stroma. Hum Pathol 1986;17:185-91.  Back to cited text no. 2  [PUBMED]    
3.Lerwill MF. Biphasic lesions of the breast. Semin Diagn Pathol 2004;21:48-56.  Back to cited text no. 3  [PUBMED]    
4.Powell CM, Cranor ML, Rosen PP. Pseudoangiomatous stromal hyperplasia (PASH): A mammary stromal tumour with myofibroblastic differentiation. Am J Surg Pathol 1995;19:270-7.  Back to cited text no. 4  [PUBMED]    
5.Ibrahim RE, Sciotto CG, Weidner N. Pseudoangiomatous hyperplasia of mammary stroma: some observations regarding its clinicopathological spectrum. Cancer 1989;63:1154-60.  Back to cited text no. 5  [PUBMED]    

Correspondence Address:
Richa Goyal
9/42, Punjab Agricultural University, Ludhiana, Punjab - 141 004
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.68248

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  [Figure 1], [Figure 2]

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