Pseudoangiomatous stromal hyperplasia of the breast: multimodality imaging findings

Year 2023, Volume: 13 Issue: 5, 802 - 808, 30.09.2023

Nilgün Güldoğan , Aydan Arslan , Safa Özyılmaz , Ebru Yılmaz , Ebru Banu Türk , Cumhur Topal

https://doi.org/10.16899/jcm.1341545

Abstract

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.

Keywords

breast tumor, pseudoangiomatous hyperplasia, ultrasound, mammography, MRI

MEMEDE PSÖDOANJİOMATÖZ STROMAL HİPERPLAZİ : GÖRÜNTÜLEME BULGULARI

Abstract

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.

Keywords

meme tümörü, pseudoanjiomatöz hiperplazi, ultrason, mamografi, MRG

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