PURPOSE: Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare, benign condition that can be mistaken as a fibroadenoma on an ultrasound examination or as a low-grade angiosarcoma on a histological examination. The objective of this study was to evaluate the ultrasound features and to present biopsy methods to correctly identify PASH. PATIENTS AND METHODS: We retrospectively reviewed the data of 55 women who were diagnosed with PASH of the breast. Ultrasound features were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS; American College of Radiology). The diagnostic ability of different biopsy methods such as core needle biopsy, vacuum-assisted biopsy and excisional biopsy were analyzed with the final histopathological results of surgical specimens. RESULTS: PASH presented as a circumscribed solid mass, with hypoechoic texture with or without heterogeneity, and a parallel orientation. The features of small, internal cysts or vascular channels and no calcifications can be used to differentiate the lesions from fibroadenomas. A core needle biopsy misdiagnosed PASH in 13 cases out of 28 cases and vacuum-assisted biopsy correctly identified PASH in all 3 cases. CONCLUSION: Ultrasound features of PASH should be noted when performing a biopsy. For inconclusive cases of PASH, an excisional biopsy followed by an initial core biopsy should be performed.
Biopsy/methods ; Breast/*pathology ; Breast Diseases/*diagnosis/pathology/ultrasonography ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia/diagnosis/ultrasonography ; Retrospective Studies ; Stromal Cells/pathology/ultrasonography ; Ultrasonography, Mammary

Endometriosis is a condition where uterine mucosal tissue is located outside of the uterus, which may be pelvic or extrapelvic. The term endometrioma is used when extrapelvic endometriosis appears as a discrete mass. A 34-year-old female, with an abdominal mass along the scar site of a cesarean section, was transferred from her local hospital following the diagnosis of a foreign body granuloma or infected lipoma. The patient had history of two cesarean sections, 5 and 7.5 years previously. The abdominal mass was associated with abdominal pain, which increased in severity during her menstrual cycle. The ultrasonography showed a solid irregular, ill defined mass, with heterogeneous echogenicity. The cytological findings showed epithelial and stromal cells. A mass excision was performed under local anesthesia. The final pathology results confirmed an endometrioma in the abdominal wall, and the microscopic findings indicated benign endometrial glands, with surrounding spindled endometrial cells in the soft tissue of the abdominal wall. The treatment of choice is wide local excision of endometrial tissue, with a clear margin. An endometrioma in the abdominal scar, following a cesarean section, is a rare event, but may be more frequent than estimated from the literature. This case was reported with a brief review of the literature.
Abdominal Pain ; Abdominal Wall ; Adult ; Anesthesia, Local ; Cesarean Section ; Cicatrix* ; Diagnosis ; Endometriosis* ; Female ; Granuloma, Foreign-Body ; Humans ; Lipoma ; Menstrual Cycle ; Mucous Membrane ; Pathology ; Pregnancy ; Stromal Cells ; Ultrasonography ; Uterus

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.
Angiomatosis/*pathology/surgery/ultrasonography ; Biopsy, Needle ; Breast/cytology/pathology/surgery ; Breast Diseases/*pathology/surgery/ultrasonography ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Hyperplasia ; Image Enhancement/methods ; Magnetic Resonance Imaging/methods ; Mammography/methods ; Middle Aged ; Stromal Cells/pathology