| Abstrakt: |
A74-year-old woman was noted to have a lesion in her right breast. It was painless and had been present for an unknown period. There were no other associated symptoms. A clinically large, firm, non-tender mass (3×4 cm) was felt in the upper outer quadrant of the right breast. There was minimal adherence to overlying tissue. On further examination, no evidence of metastatic disease was found. There was no past history of breast disease.Mammography demonstrated a well-circumscribed soft tissue mass (40 mm) without associated microcalcification or conspicuous regions of fat density (Figure 1).Ultrasound demonstrated an ellipsoid, lobular, solid mass of variable parenchymal reflectivity (Figure 1). No cystic component was identified. The mass was predominantly hyperreflective compared with adjacent parenchyma, with a few regions casting acoustic shadowing. Colour Doppler energy imaging demonstrated prominent abnormal vessels within the mass.Based on the clinical findings a provisional diagnosis of a carcinoma was made. In view of the hyperreflectivity, vascularity, and relatively small amount of acoustic shadowing, a differential diagnosis of hamartoma, phylloides tumour or sarcoma was offered.Under ultrasound guidance, core biopsy was undertaken. A diagnosis of pseudoangiomatous hyperplasia of mammary stroma (PASH) was made, although angiocarcinoma could not be excluded.The mass was then surgically excised. The tumour was of a rubbery texture and was shelled out from the surrounding stroma with ease. It had a capsule and was solid throughout (Figure 2). Further histology confirmed the core biopsy diagnosis of PASH (Figure 3). This was supported by immunohistochemistry. The patient recovered without incident. |
