Novel Pseudoangiomatous Stromal Hyperplasia Mass in a Breast Hamartoma: A Case Report

Beau Doerr^1, , Shemar Crawford², Brian Nykanen² and Cole Burr³

¹Touro College of Osteopathic Medicine - Middletown Campus, 60 Prospect Ave, Middletown, NY, 10940

²Florida State College of Medicine, 1115 W Call Street, Tallahassee, FL, 32304

³Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859

Cite this paper

Beau Doerr, Shemar Crawford, Brian Nykanen and Cole Burr. Novel Pseudoangiomatous Stromal Hyperplasia Mass in a Breast Hamartoma: A Case Report. American Journal of Medical Case Reports. 2022; 10(12):307-310. doi: 10.12691/AJMCR-10-12-3

Abstract

Breast fibroadenolipomas, otherwise known as hamartomas, are a relatively rare finding in regard to the occurrence of breast masses. Breast hamartomas make up approximately 4.8% of benign breast tumors in women. Breast hamartomas are uncommon, and our case presents with a 4.7 cm hamartoma with a focal, irregular mass inside of it which was histologically confirmed as pseudoangiomatous stromal hyperplasia (PASH). PASH is a benign mesenchymal lesion of the breast that is characterized by dense collagenous stroma forming “pseudoangiomatous” capillary-like spaces lined by spindle cells. [1] A rare condition overall, PASH is predominately discovered in premenopausal women, with fewer than 1,500 cases of PASH documented in literature [1]. Therefore, our case presentation describes a combination of two relatively rare phenomena within one palpable breast mass. Due to the absence of symptoms, the patient was scheduled for interval follow up to monitor the breast hamartoma for interval change in size, and definitive treatment by elective surgical excision was offered if accompanying symptoms developed.

Keywords

breast hamartoma, breast mass, pseudoangiomatous stromal hyperplasia, ultrasound, mammography

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Estes, Ashley, et al. “Pseudoangiomatous Stromal Hyperplasia: Overview and Clinical Management.” Annals of Breast Surgery, AME Publishing Company, 13 Nov. 2020, https://abs.amegroups.com/article/view/6368/html.
[2]	Hargaden GC, Yeh ED, Georgian-Smith D, Moore RH, Rafferty EA, Halpern EF, McKee GT. Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia. AJR Am J Roentgenol. 2008 Aug; 191(2): 359-63.
[3]	Sevim, Y., Kocaay, A. F., Eker, T., Celasin, H., Karabork, A., Erden, E., & Genc, V. (2014). Breast hamartoma: a clinicopathologic analysis of 27 cases and a literature review. Clinics (Sao Paulo, Brazil), 69(8), 515-523.
[4]	Bhatia, Mukul, et al. “‘Breast within a Breast’ Sign: Mammary Hamartoma.” Medical Journal, Armed Forces India, Elsevier, Oct. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646936/.
[5]	Lee, E.H., et al. “Invasive Ductal Carcinoma Arising in a Breast Hamartoma: Two Case Reports and a Review of the Literature.” Clinical Radiology, W.B. Saunders, 29 Jan. 2003, https://www.sciencedirect.com/science/article/abs/pii/S0009926002004567.
[6]	Vuitch, M. F., Rosen, P. P., & Erlandson, R. A. (1986). Pseudoangiomatous hyperplasia of mammary stroma. Human pathology, 17(2), 185-191.
[7]	Wieman, S. M., Landercasper, J., Johnson, J. M., Ellis, R. L., Wester, S. M., Lambert, P. J., & Ross, L. A. (2008). Tumoral pseudoangiomatous stromal hyperplasia of the breast. The American surgeon, 74(12), 1211-1214.
[8]	Pruthi, S., Reynolds, C., Johnson, R. E., & Gisvold, J. J. (2001). Tamoxifen in the management of pseudoangiomatous stromal hyperplasia. The breast journal, 7(6), 434-439.
[9]	Bowman, E., Oprea, G., Okoli, J., Gundry, K., Rizzo, M., Gabram-Mendola, S., Manne, U., Smith, G., Pambuccian, S., & Bumpers, H. L. (2012). Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a series of 24 patients. The breast journal, 18(3), 242–247.
[10]	Tse, G. M., Law, B. K., Ma, T. K., Chan, A. B., Pang, L. M., Chu, W. C., & Cheung, H. S. (2002). Hamartoma of the breast: a clinicopathological review. Journal of clinical pathology, 55(12), 951-954.
[11]	Arrigoni, M. G., Dockerty, M. B., & Judd, E. S. (1971). The identification and treatment of mammary hamartoma. Surgery, gynecology & obstetrics, 133(4), 577-582.
[12]	Chiacchio, R., Panico, L., D'Antonio, A., Delrio, P., Bifano, D., Avallone, M., & Pettinato, G. (1999). Mammary hamartomas: an immunohistochemical study of ten cases. Pathology, research and practice, 195(4), 231-236.
[13]	Herbert, M., Sandbank, J., Liokumovich, P., Yanai, O., Pappo, I., Karni, T., & Segal, M. (2002). Breast hamartomas: clinicopathological and immunohistochemical studies of 24 cases. Histopathology, 41(1), 30-34.
[14]	Feder, J. M., de Paredes, E. S., Hogge, J. P., & Wilken, J. J. (1999). Unusual breast lesions: radiologic-pathologic correlation. Radiographics : a review publication of the Radiological Society of North America, Inc, 19 Spec No, S11-S260.
[15]	R.A. Amir, S.S. Sheikh, Breast hamartoma: A report of 14 cases of an under-recognized and under-reported entity, International Journal of Surgery Case Reports, Volume 22, 2016, Pages 1-4, ISSN 2210-2612.
[16]	Baik, H., Kim, J. W., Park, Y. M., Jung, S. J., Lee, A., Yoon, H. K., & Kim, T. H. (2016). Huge Bilateral Breast Hamartoma Accompanied with Pseudoangiomatous Stromal Hyperplasia. Journal of Breast Disease, 4(1), 28-32.
[17]	Su, C. C., Chen, C. J., Kuo, S. J., & Chen, D. R. (2015). Myoid hamartoma of the breast with focal chondromyoxid metaplasia and pseudoangiomatous stromal hyperplasia: A case report. Oncology letters, 9(4), 1787-1789.
[18]	Bowman, Erin, et al. “Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast: A Series of 24 Patients.” The Breast Journal, U.S. National Library of Medicine, 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658111/.