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.