Tumorous PASH Concerns

Dee930

Hi all! Relatively new user here, (3rd post, woo!) but I wanted to thank everyone for sharing their stories— this has been literally the ONLY place I could find information about Pseudoangiomatous Stromal Hyperplasia from others' personal experiences.

I haven't heard many stories about women my age, so thought I'd share here. I will be 28 in two weeks!

During a routine breast exam at my annual obgyn visit in January, my dr felt a palpable lump in my right breast. She seemed concerned and sent me for an ultrasound scheduled the following day. The ultrasound determined that it was indeed a tumor, not a cyst, and that they would need to perform an ultrasound guided core biopsy. I had my core biopsy done in January 2019, and that's when I received the PASH diagnosis. I was told not to worry— it was benign and didn't cause cancer, just "monitor it." Whew!

However, since the procedure I have experienced notable pain in that area. At first I dismissed it to nerve pain or damaged tissue, but more time went by and it didn't improve. Initially before the procedure it would take me a while feeling around to find the lump. Now, as of September 2019, my right breast is dense with what appears to be a very palpable mass. I called my obgyn and made an appointment to see her yesterday, as she was the one who originally discovered it and frankly I didn't know what else to do.

Upon examination, she confirmed that the tumor had grown and noted that it was nodular and tender. She said that she has not had any other patients with a diagnosis of tumorous PASH, and agreed in my concern to seek more testing.

I have an appointment at the radiology lab tomorrow for another ultrasound, but I have mixed feelings about it. I did have my obgyn note in the image referral interest in MRI and consultation with a breast specialist. I am confused as to how a radiologist would be so confident in a diagnosis when tumorous PASH is so rare with very little information available. My pathology report from my core biopsy in January stated that the samples were unstained and they did not feel the need to place a clip marker.

What would another ultrasound do at this point that an MRI wouldn't? I feel like I'm at a loss as to how to proceed in regards to testing and seeking necessary follow-up, especially since these cases are so uncommon.

I've read some studies about women receiving a diagnosis of PASH, who later discovered that the PASH tumor was actually masking something more serious. I'm trying not to be a hypochondriac— I'm usually never proactive about my health but I am pretty concerned about my current situation. Any stories or insight is greatly appreciated!

Thank you all!!!

-Diana

Chemistry91

So sorry you are having to deal with this. PASH is a frustrating disease. Tumorous PASH is rare and many doctors are not really familiar with it. I would definitely see a breast specialist. They are likely to have seen it and can guide you towards treatment. I have PASH and have had many ultrasounds over the years but never an MRI. I was told that an MRI would produce a false positive with PASH. Really the only way to definitively know is with tissue. My PASH was watched for about 3 years and it continued to grow. Because of the growth it was decided that it should be removed. I go for my 2 year ultrasound soon and I am hoping it hasn’t come back. Good luck to you!! Hang in there!

OnTarget

I had PASH in both my breasts, but didn't know until the pathology of my BMX. Not really helpful but weird that I had PASH and ILC in both.

godisone

Pseudoangiomatous stromal hyperplasia (PASH) is a rare and benign breast lesion belonging to an informal group of benign stromal lesions. The condition may present clinically as a firm but painless breast mass. Patients usually describe a palpable PASH mass as mobile, firm, and painless.The average age of development of pseudo-angiomatous stromal hyperplasia of the breast is about 50, but there is quite a bit of variability. PASH of the breast usually presents in females within the 'child bearing' age group, but has been noted in children as young as 12, and in women in their early 70's. Pseudoangiomatous stromal hyperplasia is a mesenchymal lesion that forms from genetically immature muscle and connective tissue cells.Mammography, ultrasonography and sonoelastography features are illustrated with histopathological correlation.

The cause of pseudoangiomatous hyperplasia of the breast is not known, but it is suspected that the 'aberrant reactivity' of myofibroblasts to endogenous or exogenous hormones, and in particular the sex hormones, might be an important contributing factor. Pseudoangiomatous breast stromal hyperplasia is considered to be a benign lesion.Treatment for PASH is usually with a wide local excision. However, if there is a diffuse presentation of PASH, that can present a management problem which may necessitate a mastectomy. There are some reports of patients with pseudoangiomatous breast stromal hyperplasia and symptoms of breast enlargement and pain who respond well to tamoxifen. However, considering the potential side effects of long term Tamoxifen use, it is sometimes not recommended