Samaila Modupeola Omotara, Aliyu Halima Oziohu, Yusufu Lazarus Mungu, Abdullahi Shehu
Department of Pathology, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Department of Surgery, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Ann Afr Med. 2018 Apr-Jun;17(2):82-85. doi: 10.4103/aam.aam_27_17.
Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign mesenchymal tumor of the breast. Majority occur as diffuse lesions, and diagnosis is often incidental or in a background of other breast pathologies. Bilaterality with multiple tumoral masses in giant breasts is a rarity. We report a 34-year-old nonlactating female with 2-year history of rapid progressive painless bilateral enlargement of the breasts following surgical excision of ill-defined breast lumps which were not subjected to histopathological evaluation a year earlier. Examination revealed bilateral nontender giant breasts extending to the umbilical area with masses which were not attached to overlying skin, Grade 2 pressure ulcers on the lateral posterior breast aspects bilaterally and peau d'orange. There were no other palpable masses or lymph nodes. A clinical assessment of bilateral gigantomastia was made. Bilateral mastectomy revealed giant PASH which was confirmed with positive immunohistochemical reactivity for CD34 and vimentin. No other breast pathologies were seen with extensive sectioning. Diffuse multiple breast lesions with incomplete excision are associated with rapid growth in PASH as seen in this case. The presence of concurrent bilateral giant tumoral masses without any underlying breast pathology is a novelty. The mainstay of treatment in this case is mastectomy despite its benign nature.
假血管瘤样间质增生（PASH）是一种罕见的乳腺良性间叶肿瘤。多数表现为弥漫性病变，诊断往往是偶然的，或在其他乳腺病变的背景下发现。双侧巨大乳房出现多个肿瘤性肿块的情况极为罕见。我们报告一例34岁非哺乳期女性，在一年前手术切除边界不清的乳腺肿块后，出现双侧乳房快速进行性无痛性增大，持续2年，当时未对切除的肿块进行组织病理学评估。检查发现双侧乳房巨大，无压痛，延伸至脐部，有肿块，与覆盖皮肤不相连，双侧乳房外侧后方有2级压疮及橘皮样改变。未触及其他肿块或淋巴结。临床诊断为双侧巨乳症。双侧乳房切除术显示为巨大的PASH，免疫组化CD34和波形蛋白呈阳性反应得以证实。广泛切片未发现其他乳腺病变。如本例所见，PASH中弥漫性多发乳腺病变且切除不完全与快速生长有关。同时出现双侧巨大肿瘤性肿块且无任何潜在乳腺病变是一种新情况。尽管该病变为良性，但本例的主要治疗方法仍是乳房切除术。
