PMC10352531_01
A 39-year-old woman with symptomatic PASH. Contrast-enhanced axial MRI (a) and maximum intensity projection (MIP) (b). Images show a right outer central breast 9 : 00 anterior to a middle depth 10.1 cm heterogeneously enhancing oval mass with circumscribed margins and interspersed areas of fat (arrow), biopsy-proven PASH. The left breast also has a lower inner quadrant 7 : 00 posterior depth 4.1 cm heterogeneously enhancing oval mass with circumscribed margins (thin arrow), also later found to be biopsy-proven PASH. Approximately two years later, after excision of these two masses and treatment with a course of tamoxifen, the patient developed diffuse PASH in both breasts as seen on contrast-enhanced axial MRI (c) and MIP (d) images.
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Breast magnetic resonance imaging (MRI) showed bilateral heterogeneously enhancing oval masses with circumscribed margins, biopsies of which confirmed hypertrophic focal right PASH, and new left onset PASH at the time of symptom onset (Figures 1(a) and 1(b)). After a year of attempting to conceive by IVF, MRI showed that the PASH had become more generalized and diffuse (Figures 1(c) and 1(d)), so focal excisional biopsies were no longer an option.
Patient presentation during pregnancy. The patient presented with markedly enlarged breasts and taut darkening skin with a sluggish capillary refill.
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Her bra size had also changed from a B to a G cup (Figure 2).
Histological tissue examination of PASH. Marked edema and expansion of the interlobular stroma with areas of stromal hyperplasia, including conventional pseudoangiomatous stroma hyperplasia with clefts and fascicular PASH (a and b). On immunohistochemistry, the stromal cells were estrogen receptor-negative, smooth muscle actin positive, and CD34 positive consistent with myofibroblasts.
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Histological tissue examination showed marked edema and expansion of the interlobular stroma with areas of stromal hyperplasia, including conventional PASH with clefts, and fascicular PASH (Figures 3(a) and 3(b)).