Raj Sean D, Sahani Vivek G, Adrada Beatriz E, Scoggins Marion E, Albarracin Constance T, Woodtichartpreecha Piyanoot, Posleman Monetto Flavia E, Whitman Gary J
Department of Radiology, Baylor College of Medicine, Houston, TX.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Curr Probl Diagn Radiol. 2017 Mar-Apr;46(2):130-135. doi: 10.1067/j.cpradiol.2016.01.005. Epub 2016 Feb 2.
Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast condition. PASH is thought to be hormonally responsive, and it is usually identified in premenopausal and perimenopausal women. PASH may also be seen in postmenopausal woman on hormone replacement therapy (HRT). Approximately 53% of patients with PASH present with abnormalities on screening mammography, and 44% of patients with PASH present with palpable abnormalities. On imaging studies, PASH appears similar to fibroadenomas. On mammography, PASH is usually seen as a noncalcified, circumscribed mass. On ultrasound, PASH often appears as an oval, circumscribed, hypoechoic mass. On magnetic resonance imaging, PASH usually has progressive (Type 1) enhancement, and high-signal slit-like spaces may be seen on T2-weighted and short tau inversion recovery (STIR) images. The slit-like spaces correspond to empty clefts within acellular hyalinized stroma on histopathology. PASH may be mistaken for a low-grade angiosarcoma on pathologic examination. While angiosarcoma has true vascular spaces, PASH has a network of pseudoangiomatous slit-like clefts. Women with biopsy-proven PASH usually undergo follow-up imaging. Surgical excision may be considered for larger lesions and in women at an increased risk for developing breast cancer. In the future, additional studies are needed to provide definitive data regarding appropriate management and long-term outcomes for women with PASH. PASH has become increasingly recognized, but the literature regarding the imaging features of PASH is scarce. This paper reviews the imaging and pathologic features of PASH and some processes that may simulate PASH are discussed. Features of PASH on mammography, ultrasound, MRI, and nuclear medicine studies are discussed with pathologic correlation.
假血管瘤样间质增生（PASH）是一种罕见的乳腺良性病变。PASH被认为对激素有反应，通常在绝经前和围绝经期女性中发现。接受激素替代疗法（HRT）的绝经后女性也可能出现PASH。约53%的PASH患者在乳腺钼靶筛查时出现异常，44%的PASH患者可触及异常。在影像学检查中，PASH表现与纤维腺瘤相似。在乳腺钼靶上，PASH通常表现为非钙化的、边界清晰的肿块。在超声检查中，PASH常表现为椭圆形、边界清晰的低回声肿块。在磁共振成像上，PASH通常有渐进性（1型）强化，在T2加权和短tau反转恢复（STIR）图像上可见高信号的裂隙样间隙。这些裂隙样间隙在组织病理学上对应无细胞透明变性间质内的空虚裂隙。PASH在病理检查中可能被误诊为低级别血管肉瘤。血管肉瘤有真正的血管腔隙，而PASH有假血管瘤样裂隙样间隙网络。经活检证实为PASH的女性通常需接受随访影像学检查。对于较大病变以及乳腺癌发病风险增加的女性，可考虑手术切除。未来，需要更多研究以提供关于PASH女性患者恰当管理及长期预后的确切数据。PASH已越来越受到认可，但关于PASH影像学特征的文献较少。本文回顾了PASH的影像学和病理学特征，并讨论了一些可能模拟PASH的病变。文中结合病理学相关性讨论了PASH在乳腺钼靶、超声、MRI及核医学检查中的特征。
