Pseudoangiomatous Stromal Hyperplasia of the Breast: A Review of One Saudi Institution Experience

Background: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast fibrotic lesion. Surgery is the treatment of choice. Up to date no previous work has been published on Saudi experiences of treating PASH. Thus,... [ view full abstract ]

Background: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast fibrotic lesion. Surgery is the treatment of choice. Up to date no previous work has been published on Saudi experiences of treating PASH. Thus, this study aimed to investigate the clinical and pathological characteristic of PASH patients in our population.

Methods: A 15-years retrospective review conducted including all cases of PASH who were operated at King Faisal Specialist Hospital & Research Center.

Results: Only 15 premenopausal female patients were identified with a median age of 41(12-50) years. The majority presented with palpable mass 13(86.7%) cases, and 2(13.3%) cases discovered on radiological images. Six (40%) patients had bilateral disease, so we counted each site as one tumor. The preoperative core biopsy showed PASH in 3(20%) cases, IDC in 5(33.3%) cases, phyllodes in 2(13.3%) cases, DCIS in 2(13.3%) cases, fibroadenoma in 2(13.3%) cases, and atypical cells in 1(6.7%) case. Surgery consisted of lumpectomy in 11(47.8%) tumors, skin sparing mastectomy in 10(43.5%) tumors, modified radical mastectomy in 1(4.3%) tumor, and simple mastectomy in 1(4.3%) tumor. The final pathology showed pure PASH in 10(43.5%) tumors, and a combined pathological in 13(56.5%) tumors; IDC 8(34.8%), DCIS 4(17.4%), and fibroadenoma 1(4.3%). The median PASH size was 5 (0.5-32) cm. None of pure PASH patients died or develop recurrent with a median follow up of 58 (24-118) months.

Conclusion: Our data suggest that PASH is mainly a postoperative diagnosis. PASH usually presents together with another breast disease, but it can present as a bilateral huge breast disease.