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Pseudoangiomatous Stromal Hyperplasia (PASH)

 

What is Pseudoangiomatous Stromal Hyperplasia (PASH)?

Pseudoangiomatous Stromal Hyperplasia (PASH) is a benign (non-cancerous) breast condition characterized by the proliferation of stromal cells within the breast tissue, forming slit-like spaces that resemble blood vessels (pseudoangiomatous spaces). PASH lesions are typically well-circumscribed and may present as discrete masses or areas of thickening within the breast.

What are the symptoms of PASH?

PASH may present with various symptoms, including:

  • Palpable Breast Lump: The most common symptom of PASH is the presence of a painless, palpable lump in the breast, which may feel firm or rubbery to the touch.
  • Breast Swelling or Enlargement: Some individuals with PASH may experience breast swelling, enlargement, or changes in breast size or shape.
  • Mobility of the Lump: PASH lesions are typically mobile within the breast tissue and may change in size or shape over time, particularly in response to hormonal changes during the menstrual cycle.
  • Skin Changes: PASH is usually not associated with changes in the overlying skin of the breast, such as dimpling, puckering, or redness.

How do you diagnose PASH?

Diagnosing PASH typically involves a combination of clinical evaluation, imaging studies and biopsy:

  • Clinical Breast Exam: A healthcare provider will perform a physical examination of the breasts to assess for the presence of any palpable lumps or other abnormalities.
  • Imaging Studies: Imaging tests such as mammography, breast ultrasound, or breast MRI may be performed to evaluate the characteristics of the breast lesion and assess for any associated findings.
  • Biopsy: A tissue biopsy is necessary to confirm the diagnosis of PASH. During a biopsy, a sample of tissue is obtained from the breast lesion and examined under a microscope by a pathologist to determine the presence of characteristic features of PASH.

What are the treatment options for PASH?

The treatment approach for PASH depends on various factors, including the size and characteristics of the lesion, its associated symptoms and individual patient preferences. Treatment options may include:

  • Observation: In many cases, especially if the PASH lesion is small, asymptomatic, and confirmed to be benign, close monitoring through regular clinical breast exams and imaging studies may be recommended to ensure stability and rule out any underlying concerns.
  • Surgical Excision: If the PASH lesion is causing symptoms, enlarging, or causing concern, surgical removal (excision) of the lesion may be recommended. Surgical excision typically involves removing the entire PASH lesion along with a margin of surrounding healthy tissue to reduce the risk of recurrence.
  • Hormonal Therapy: In some cases, hormonal therapy may be considered to reduce the size or symptoms of PASH lesions, particularly for lesions that are hormone responsive.