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Analysis of the Mammographic and Sonographic Features of Pseudoangiomatous Stromal Hyperplasia

¹ Division of Breast Imaging, Department of Radiology, Avon Comprehensive Breast Center, Massachusetts General Hospital, Boston, MA.
² Present address: Breast Check, Mater Misericordiae University Hospital, 36 Eccles St., Dublin 7, Ireland.
³ Present address: Division of Breast Imaging, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.
⁴ Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.
⁵ Department of Pathology, Massachusetts General Hospital, Boston, MA.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Graph summarizes mammographic findings: normal, mass lesion (circumscribed), focal asymmetric density, and incidental finding of architectural distortion or calcifications. Light gray indicates screening group; dark gray, clinical finding group.

View larger version (25K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Graph shows pathologic findings in screening group. Pseudoangiomatous stromal hyperplasia was identified in all cases, either alone or with invasive carcinoma, fibrocystic change, fibroadenoma, atypical ductal hyperplasia, ductal carcinoma in situ, or another abnormality.

View larger version (26K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Graph shows pathologic findings in clinical group. Pseudoangiomatous stromal hyperplasia was identified in all cases either alone or with invasive carcinoma, fibrocystic change, fibroadenoma, atypical ductal hyperplasia, ductal carcinoma in situ, or another abnormality.

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —62-year-old postmenopausal woman not taking hormone replacement therapy who underwent screening mammography. Screening mammogram in extended craniocaudal (A) and mediolateral oblique (B) views shows new focal asymmetric density (arrow) in left upper outer breast compared with mammogram (not shown) obtained 3 years previously. It measures approximately 2 cm, is low in x-ray attenuation, and has ill-defined margins. Because it was new and has ill-defined margins, lesion is concerning for malignancy, and biopsy was suggested. Results of needle localization and surgical biopsy showed pseudoangiomatous stromal hyperplasia.

View larger version (81K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —62-year-old postmenopausal woman not taking hormone replacement therapy who underwent screening mammography. Screening mammogram in extended craniocaudal (A) and mediolateral oblique (B) views shows new focal asymmetric density (arrow) in left upper outer breast compared with mammogram (not shown) obtained 3 years previously. It measures approximately 2 cm, is low in x-ray attenuation, and has ill-defined margins. Because it was new and has ill-defined margins, lesion is concerning for malignancy, and biopsy was suggested. Results of needle localization and surgical biopsy showed pseudoangiomatous stromal hyperplasia.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —62-year-old postmenopausal woman not taking hormone replacement therapy who underwent screening mammography. Photomicrograph shows typical pseudoangiomatous stromal hyperplasia: anastomosing slitlike empty spaces lined by flattened myofibroblasts without RBCs. (H and E)

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —53-year-old postmenopausal woman taking hormone replacement therapy who has palpable lump. Craniocaudal (A) and mediolateral oblique (B) mammograms of left breast show mass (arrow) in retroareolar region, corresponding to patient's focal area of clinical concern. Mass measures 3 cm and has partially well-circumscribed margins and margins partially obscured by adjacent dense breast tissue.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —53-year-old postmenopausal woman taking hormone replacement therapy who has palpable lump. Craniocaudal (A) and mediolateral oblique (B) mammograms of left breast show mass (arrow) in retroareolar region, corresponding to patient's focal area of clinical concern. Mass measures 3 cm and has partially well-circumscribed margins and margins partially obscured by adjacent dense breast tissue.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —53-year-old postmenopausal woman taking hormone replacement therapy who has palpable lump. Focal sonogram corresponding to A and B shows 2.9-cm solid hypoechoic oval mass with smooth well-circumscribed margins and unusually internal cystic spaces. Sonographically guided core biopsy and pathologic examination revealed dense sclerosis and features suggestive of pseudoangiomatous stromal hyperplasia. Surgical biopsy revealed pseudoangiomatous stromal hyperplasia with associated fibrocystic changes. Crosses delineate lesion.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —53-year-old postmenopausal woman taking hormone replacement therapy who has palpable lump. High-power photomicrograph shows lesion more cellular than that in Figures 4A, 4B, and 4C. Slitlike spaces are collapsed or compressed, and many plump myofibroblasts are present. Dense collagenous stroma separates spaces. (H and E)

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