What is Pseudoangiomatous Stromal Hyperplasia, Know its Causes, Treatment, FAQ

Pseudoangiomatous Stromal Hyperplasia also known by the name of PASH. It is an extremely rare and benign pathological condition of the breasts in which there is development of palpable mass or lesions around the breasts. This condition can affect both males and females but occurs mainly in females who are within the reproductive age.

Pseudoangiomatous Stromal Hyperplasia is quite a difficult condition to diagnose because firstly it is a rare condition and not much is known about it and secondly the radiographic appearance of the mass mimic masses found in conditions like breast fibroadenoma.

In males, Pseudoangiomatous Stromal Hyperplasia can be an incidental finding when a biopsy is being conducted for gynecomastia in males. In females too, when radiology tests are being conducted for some other medical condition an incidental finding is made of Pseudoangiomatous Stromal Hyperplasia.

The exact cause of Pseudoangiomatous Stromal Hyperplasia is not yet known as the condition is extremely rare but it presents itself as a painless but firm mass in the breasts. If this condition occurs in a pregnant female then it may lead to abnormal enlargement of the breasts and make the skin necrotic.

Majority of the cases of Pseudoangiomatous Stromal Hyperplasia are identified radiologically as an incidental finding when the tests are being conducted for some other condition. Pseudoangiomatous Stromal Hyperplasia usually occurs in females in the reproductive age but they are also not uncommon in males who have a presumed diagnosis of gynecomastia.

The mass formed in Pseudoangiomatous Stromal Hyperplasia is usually from genetically immature muscles and connective tissues and hence they are called mesenchymal lesions. There are mostly composed of myofibroblasts but in some cases glandular components are also a part of the mass formed due to Pseudoangiomatous Stromal Hyperplasia.

The most accepted hypothesis as to the cause of Pseudoangiomatous Stromal Hyperplasia is an aberrant reactivity of these myofibroblasts to hormonal stimuli, particularly the sex hormones in females resulting in Pseudoangiomatous Stromal Hyperplasia.

Pseudoangiomatous Stromal Hyperplasia is basically a benign mass and the most preferred treatment of this condition is excision of the mass. This is usually done in a wide local fashion. If there are multiple masses scattered all across the breasts then excision of each mass becomes difficult and in such cases may requite a complete mastectomy or removal of the breast.

In some cases, where there is abnormal enlargement of breasts due to Pseudoangiomatous Stromal Hyperplasia then medication called tamoxifen has been found to be effective but the side effect profile of long term use of this medications is a cause of concern and hence is usually not recommended.

Chemical therapy of any kind is not recommended due to the benign and harmless in nature with a recurrence rate percentage of only 20% of Pseudoangiomatous Stromal Hyperplasia.

Some of the frequent questions that are asked by patients diagnosed with Pseudoangiomatous Stromal Hyperplasia are:

A. The answer to this is that this condition is absolutely benign and has no chance of becoming malignant

A. The answer to this is mentioned above that males with suspected gynecomastia are sometimes end up being diagnosed with Pseudoangiomatous Stromal Hyperplasia.

A. The answer to this is again no. There is no increased risk of breast cancer due to Pseudoangiomatous Stromal Hyperplasia

A. Studies suggest that there is a recurrence rate of about 20% in patients who have been successfully treated for Pseudoangiomatous Stromal Hyperplasia.