A case of large Fibroadenoma with pseudoangiomatous stromal hyperplasia (PASH-like) stroma in a 15 year old girl

Objective PASH is a rare, benign lesion of the breast usually diagnosed via CNB. If imaging appearance and histopathological findings are conclusive and no suspicious features like fast growth present, surgical excision is not required. In cases where PASH was surgically removed, different approaches including mastectomy have been published. This raises the question of optimal treatment of this benign lesion if excision is indicated due to e.g. significant breast enlargement or pain.

Case We present the case of a 15 year old girl that presented with enlargement of the right breast and a palpable mass. Ultrasound and CNB confirmed an 11 cm PASH filling both upper quadrants. Because of fast growth and obvious breast asymmetry the patient opted for surgical excision. Due to her age we performed tumor enucleation without glandular rotation or tumor adapted reduction mammoplasty as we expected good cosmetic outcome after removal of the PASH. In the unlikely case of breast contour deficiency, we agreed to perform a second, form correcting surgery.

Results After enucleation of the tumor via periareolar incision, the natural breast shape and breast symmetry recovered within single days. Final histopathological diagnosis was a Fibroadenoma with pseudoangiomatous (PASH-like) stroma. After twelve months there is no sign of recurrence.

Discussion Simple enucleation of large CNB confirmed PASH is a sufficient and safe approach to achieve good cosmetic outcome and preserve breast feeding capability.

Publication History

Article published online:
21 June 2022