Yonsei Med J.  2008 Oct;49(5):757-764. 10.3349/ymj.2008.49.5.757.

Diagnosis of Pseudoangiomatous Stromal Hyperplasia of the Breast: Ultrasonography Findings and Different Biopsy Methods

• Choi YJ
• Ko EY
• Kook S

• KMID: 2158194
• DOI: http://doi.org/10.3349/ymj.2008.49.5.757

Abstract

PURPOSE
Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare, benign condition that can be mistaken as a fibroadenoma on an ultrasound examination or as a low-grade angiosarcoma on a histological examination. The objective of this study was to evaluate the ultrasound features and to present biopsy methods to correctly identify PASH. PATIENTS AND METHODS: We retrospectively reviewed the data of 55 women who were diagnosed with PASH of the breast. Ultrasound features were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS; American College of Radiology). The diagnostic ability of different biopsy methods such as core needle biopsy, vacuum-assisted biopsy and excisional biopsy were analyzed with the final histopathological results of surgical specimens. RESULTS: PASH presented as a circumscribed solid mass, with hypoechoic texture with or without heterogeneity, and a parallel orientation. The features of small, internal cysts or vascular channels and no calcifications can be used to differentiate the lesions from fibroadenomas. A core needle biopsy misdiagnosed PASH in 13 cases out of 28 cases and vacuum-assisted biopsy correctly identified PASH in all 3 cases. CONCLUSION: Ultrasound features of PASH should be noted when performing a biopsy. For inconclusive cases of PASH, an excisional biopsy followed by an initial core biopsy should be performed.

Keyword

Pseudoangiomatous stromal hyperplasia; breast; ultrasound; biopsy

MeSH Terms

Biopsy/methods
Breast/*pathology
Breast Diseases/*diagnosis/pathology/ultrasonography
Diagnosis, Differential
Female
Humans
Hyperplasia/diagnosis/ultrasonography
Retrospective Studies
Stromal Cells/pathology/ultrasonography
Ultrasonography, Mammary

Figure

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  Fig. 1 Transverse sonography of PASH shows an approximate 5 cm sized well-circumscribed homogeneous hypoechoic oval mass in a 30-year-old woman who presented with a palpable mass in the right breast. PASH, pseudoangiomatous stromal hyperplasia.

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  Fig. 2 (A) Sonography demonstrates a well-circumscribed homogeneous hypoechoic mass. (B) Doppler US shows vascular channels (arrows) in the lesion. In these cases, a histological examination also identified the presence of vascular channels. US, ultrasound.

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  Fig. 3 Fibrocystic change was confirmed after an initial core needle biopsy, but surgical excision identified PASH in a 42-year-old premenopausal woman with BI-RADS category 4a. US shows a 2.8 cm sized heterogeneous echoic nodule mixed with an ill-defined margin with an irregular shape. PASH, pseudoangiomatous stromal hyperplasia; BI-RADS, breast imaging reporting and data system; US, ultrasound.

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  Fig. 4 Transverse (A) and longitudinal (B) breast US scans. A nodule, characterized as BI-RADS category 4b, was irregular in shape, not parallel to the breast axis with a spiculated margin, and was hypoechoic with posterior shadowing and an echogenic halo, which presented as a cancer or radial scar. This case was originally diagnosed after a core biopsy and was confirmed as stromal fibrosis, but an excisional biopsy identified the lesion as PASH. BI-RADS, breast imaging reporting and data system; PASH, pseudoangiomatous stromal hyperplasia; US, ultrasound.

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  Fig. 5 Transverse (A) and longitudinal (B) breast US scans. This circumscribed round but not parallel to the chest wall PASH lesion was initially diagnosed as a fibroadenoma after a core biopsy. PASH, pseudoangiomatous stromal hyperplasia; US, ultrasound.

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  Fig. 6 Non-mass-forming PASH. PASH was depicted not as a mass but as low echoic lesions intermingled with the normal parenchyma. The initial pathological diagnosis of this case was fibrocystic change, but the lesion was identified as PASH after surgical excision. PASH, pseudoangiomatous stromal hyperplasia.

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