Klinik Araştırma
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Pseudoangiomatous stromal hyperplasia of the breast: multimodality imaging findings

Yıl 2023, Cilt: 13 Sayı: 5, 802 - 808, 30.09.2023
https://doi.org/10.16899/jcm.1341545

Öz

Background/Aim: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign mesenchymal proliferative breast lesion. The literature contains little information on the radiological results of this uncommon tumor. In this study, we aim to define the radiologic findings of PASH through our institutional experience.
Materials and Methods: Patients with PASH of the breast reported in the surgical database of our institution from 2020 to 2023 were retrospectively reviewed. PASH was detected in 11 female patients among the patients who underwent a total of 2172 breast tru-cut biopsies. Nine patients whose imaging studies could be recalled from the picture archiving systems (PACS) were included in the study. BI-RADS, 5th edition, was used to analyze and classify radiologic findings.
Results: The median age of cases was 41 (range 22–53). Our single-center incidence was found to be 0.5%. Considering the sonographic findings, all of the lesions had an oval shape. On mammography, they were defined as focal asymmetry or circumscribed masses. An MRI was available in three cases. All three cases were hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences. They displayed type 1 or type 2 enhancement curves in the dynamic contrast-enhanced images. No diffusion restriction was detected.
Conclusion: In this study, tumor-forming PASH were generally circumscribed oval hypoechoic solid masses with minimal vascularity and no posterior acoustic features on ultrasound. On mammography, calcification, architectural distortion, or spiculation were not present in any of the cases. MRI findings were t2 hyperintensity, type 1–2 enhancement kinetics, and no diffusion restriction. In all imaging modalities, the imaging characteristics point to a benign lesion.

Kaynakça

  • 1. Vuitch MF, Rosen PP, Erlandson RA. Pseudoangiomatous hyperplasia of mammary stroma. Hum Pathol. 1986 Feb;17(2):185-91.
  • 2. AbdullGaffar B. Pseudoangiomatous stromal hyperplasia of the breast. Arch Pathol Lab Med. 2009 Aug;133(8):1335-8.
  • 3. Ibrahim RE, Sciotto CG, Weidner N. Pseudoangiomatous hyperplasia of mammary stroma. Some observations regarding its clinicopathologic spectrum. Cancer. 1989 Mar 15;63(6):1154-60.
  • 4. Raj SD, Sahani VG, Adrada BE, et al. Pseudoangiomatous Stromal Hyperplasia of the Breast: Multimodality Review With Pathologic Correlation. Curr Probl Diagn Radiol. 2017 Mar-Apr;46(2):130-135.
  • 5. Hargaden GC, Yeh ED, Georgian-Smith D, et al. Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia. AJR Am J Roentgenol. 2008 Aug;191(2):359-63.
  • 6. Celliers L, Wong DD, Bourke A. Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features. Clin Radiol. 2010 Feb;65(2):145-9.
  • 7. Jones KN, Glazebrook KN, Reynolds C. Pseudoangiomatous stromal hyperplasia: imaging findings with pathologic and clinical correlation. AJR Am J Roentgenol. 2010 Oct;195(4):1036-42.
  • 8. D’Orsi CJ, Sickles EA, Mendelson EB, et al. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013
  • 9. Polger MR, Denison CM, Lester S, Meyer JE. Pseudoangiomatous stromal hyperplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 1996 Feb;166(2):349-52.
  • 10. Cohen MA, Morris EA, Rosen PP, Dershaw DD, Liberman L, Abramson AF. Pseudoangiomatous stromal hyperplasia: mammographic, sonographic, and clinical patterns. Radiology. 1996 Jan;198(1):117-20.
  • 11. Nia ES, Adrada BE, Whitman GJ, et al. MRI features of pseudoangiomatous stromal hyperplasia with histopathological correlation. Breast J. 2021 Mar;27(3):242-247.
  • 12. Virk RK, Khan A. Pseudoangiomatous stromal hyperplasia: an overview. Arch Pathol Lab Med. 2010 Jul;134(7):1070-4.
  • 13. Alikhassi A, Ensani F, Omranipour R, Abdollahi A. Bilateral Simultaneous Pseudoangiomatous Stromal Hyperplasia of the Breasts and Axillae: Imaging Findings with Pathological and Clinical Correlation. Case Rep Radiol. 2016;2016: 9084820.
  • 14. Presentation and management - a clinical perspective. SA J Radiol. 2018 Oct 29;22(2):1366.
  • 15. Rosen PP. Rosen’s Breast Pathology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: p8.
  • 16. Nassar H, Elieff MP, Kronz JD, Argani P. Pseudoangiomatous stromal hyperplasia (PASH) of the breast with foci of morphologic malignancy: a case of PASH with malignant transformation? Int J Surg Pathol. 2010 Dec;18(6):564-9
  • 17. Ferreira M, Albarracin CT, Resetkova E. Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases. Mod Pathol. 2008 Feb;21(2):201-7.
  • 18. Degnim AC, Frost MH, Radisky DC, et al. Pseudoangiomatous stromal hyperplasia and breast cancer risk. Ann Surg Oncol. 2010 Dec;17(12):3269-77.

MEMEDE PSÖDOANJİOMATÖZ STROMAL HİPERPLAZİ : GÖRÜNTÜLEME BULGULARI

Yıl 2023, Cilt: 13 Sayı: 5, 802 - 808, 30.09.2023
https://doi.org/10.16899/jcm.1341545

Öz

Giriş/Amaç: Psödoanjiyomatöz stromal hiperplazi (PASH) memenin nadir görülen benign mezenkimal proliferatif lezyonudur. Literatür, bu nadir tümörün radyolojik sonuçları hakkında çok az bilgi içermektedir. Bu çalışmada PASH'ın radyolojik bulgularını kurumsal deneyimlerimizden hareketle tanımlamayı amaçladık.
Yöntem: Kurumumuzun cerrahi veri tabanında 2020-2023 yılları arasında bildirilen meme PASH'li hastalar retrospektif olarak incelendi. Toplam 2172 meme tru-cut biyopsisi yapılan hastalardan 11'inde kadın hastada PASH saptandı. Görüntüleme çalışmaları resim arşivleme sistemlerinden (PACS) geri çağrılabilen dokuz hasta çalışmaya dahil edildi. BI-RADS 5. baskı, radyolojik bulguları analiz etmek ve sınıflandırmak için kullanıldı.
Bulgular: Olguların ortanca yaşı 41'di (22-53 arası). Tek merkezli insidansımız %0,5 olarak bulundu. Sonografik bulgulara bakıldığında lezyonların tamamı oval bir şekle sahipti. Mamografide fokal asimetri veya sınırlı kitleler olarak tanımlandı. 3 olguda MRG mevcuttu. 3 vakanın tümü, T1 ağırlıklı sekanslarda hipointens ve T2 ağırlıklı sekanslarda hiperintens idi. Dinamik kontrastlı görüntülerde tip 1 veya tip 2 geliştirme eğrileri gösterdiler. Difüzyon kısıtlaması saptanmadı.
Sonuç: Bu çalışmada, tümör oluşturan PASH'lar genel olarak sınırlı, minimal vaskülariteye sahip, ultrasonda posterior akustik özelliği olmayan, oval hipoekoik solid kitlelerdi. Mamografide kalsifikasyon, distorsiyon veya spikülasyon olguların hiçbirinde yoktu. MRG bulguları t2 hiperintensite, tip 1-2 kontrastlanma kinetiği ve difüzyon kısıtlaması olmamasıydı. Tüm görüntüleme modalitelerinde, görüntüleme özellikleri iyi huylu bir lezyona işaret etmekteydi.

Kaynakça

  • 1. Vuitch MF, Rosen PP, Erlandson RA. Pseudoangiomatous hyperplasia of mammary stroma. Hum Pathol. 1986 Feb;17(2):185-91.
  • 2. AbdullGaffar B. Pseudoangiomatous stromal hyperplasia of the breast. Arch Pathol Lab Med. 2009 Aug;133(8):1335-8.
  • 3. Ibrahim RE, Sciotto CG, Weidner N. Pseudoangiomatous hyperplasia of mammary stroma. Some observations regarding its clinicopathologic spectrum. Cancer. 1989 Mar 15;63(6):1154-60.
  • 4. Raj SD, Sahani VG, Adrada BE, et al. Pseudoangiomatous Stromal Hyperplasia of the Breast: Multimodality Review With Pathologic Correlation. Curr Probl Diagn Radiol. 2017 Mar-Apr;46(2):130-135.
  • 5. Hargaden GC, Yeh ED, Georgian-Smith D, et al. Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia. AJR Am J Roentgenol. 2008 Aug;191(2):359-63.
  • 6. Celliers L, Wong DD, Bourke A. Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features. Clin Radiol. 2010 Feb;65(2):145-9.
  • 7. Jones KN, Glazebrook KN, Reynolds C. Pseudoangiomatous stromal hyperplasia: imaging findings with pathologic and clinical correlation. AJR Am J Roentgenol. 2010 Oct;195(4):1036-42.
  • 8. D’Orsi CJ, Sickles EA, Mendelson EB, et al. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013
  • 9. Polger MR, Denison CM, Lester S, Meyer JE. Pseudoangiomatous stromal hyperplasia: mammographic and sonographic appearances. AJR Am J Roentgenol. 1996 Feb;166(2):349-52.
  • 10. Cohen MA, Morris EA, Rosen PP, Dershaw DD, Liberman L, Abramson AF. Pseudoangiomatous stromal hyperplasia: mammographic, sonographic, and clinical patterns. Radiology. 1996 Jan;198(1):117-20.
  • 11. Nia ES, Adrada BE, Whitman GJ, et al. MRI features of pseudoangiomatous stromal hyperplasia with histopathological correlation. Breast J. 2021 Mar;27(3):242-247.
  • 12. Virk RK, Khan A. Pseudoangiomatous stromal hyperplasia: an overview. Arch Pathol Lab Med. 2010 Jul;134(7):1070-4.
  • 13. Alikhassi A, Ensani F, Omranipour R, Abdollahi A. Bilateral Simultaneous Pseudoangiomatous Stromal Hyperplasia of the Breasts and Axillae: Imaging Findings with Pathological and Clinical Correlation. Case Rep Radiol. 2016;2016: 9084820.
  • 14. Presentation and management - a clinical perspective. SA J Radiol. 2018 Oct 29;22(2):1366.
  • 15. Rosen PP. Rosen’s Breast Pathology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009: p8.
  • 16. Nassar H, Elieff MP, Kronz JD, Argani P. Pseudoangiomatous stromal hyperplasia (PASH) of the breast with foci of morphologic malignancy: a case of PASH with malignant transformation? Int J Surg Pathol. 2010 Dec;18(6):564-9
  • 17. Ferreira M, Albarracin CT, Resetkova E. Pseudoangiomatous stromal hyperplasia tumor: a clinical, radiologic and pathologic study of 26 cases. Mod Pathol. 2008 Feb;21(2):201-7.
  • 18. Degnim AC, Frost MH, Radisky DC, et al. Pseudoangiomatous stromal hyperplasia and breast cancer risk. Ann Surg Oncol. 2010 Dec;17(12):3269-77.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Radyoloji ve Organ Görüntüleme
Bölüm Orjinal Araştırma
Yazarlar

Nilgün Güldoğan 0000-0001-8322-8374

Aydan Arslan 0000-0002-6073-1927

Safa Özyılmaz 0009-0002-2041-1037

Ebru Yılmaz 0000-0001-8681-1565

Ebru Banu Türk 0000-0003-1219-0553

Cumhur Topal 0000-0001-6782-2373

Yayımlanma Tarihi 30 Eylül 2023
Kabul Tarihi 7 Eylül 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 13 Sayı: 5

Kaynak Göster

AMA Güldoğan N, Arslan A, Özyılmaz S, Yılmaz E, Türk EB, Topal C. Pseudoangiomatous stromal hyperplasia of the breast: multimodality imaging findings. J Contemp Med. Eylül 2023;13(5):802-808. doi:10.16899/jcm.1341545