Enlarging nonpalpable mass = PASH

[mary1000]

I have had a mass enlarging over the past few years, now approx 2 cm on mammogram. .  Last month had ultrasound, dx solid mass, then last week had core needle biopsy which I was told on phone is benign.  Received biopsy report today and although benign (I am grateful)  the dx is pseudoangiomatous stromal hyperplasia (PASH).  I understand from the internet that it is rare for this condition to present as a mass, and rarer still in postmenopausaal women (I am 66.)  I am wondering what the care will be for this condition, what should I expect.  I have an appointment with the breast clinic nurse a month from now, but it seems a long time to wait for some information. Will they want to do surgery, what kind, or just watch it? Any other treatment available?  Thank you.

[katarina777]

I know I sound just like the doctor's answers I myself do not appreciate, (this place is an exception), with the usual: "speak to your MD, as only he knows best."  But, in this case, i really think you should call them and tell them that you are anxious about this diagnosis and you are hoping to get some idea what this means and how it will be treated, or recommended to be treated, and that you cannot wait for a month. And, I am sure they will be happy to provide you with some information about your specific case, either the doctor, or his nurse. I would call right away if I were you and for the same reason you want to know. it's totally normal , and reasonable that you get  feedback about this. and I would do that even if Dr. Santos responds back to you, the doctors are great here, but he won't be able to answer your question as well as your own doctor.

[mary1000]

I wonder what might be going to be recommended in my case.  Not that you can predict, but does it seem possible/likely that the more extreme measures you describe will be recommended? There is no associated malignancy.  The mass is now 1,9 cm on mammography.  Last year it was 1.5 cm.  Is this "small?"  Why might this mass have to be "treated?"  

I appreciate your response very much.

[Dr Santos]

How are you? Pseudoangiomatous stromal hyperplasia (PASH) of the
breast was first described in 1986 by Vuitch et al. and presents either as an incidental microscopic finding or a clinically palpable lesion. The etiology of PASH is unknown but hormonal factors are thought to be involved.

The management strategies of PASH may be surgical or non-surgical. Surgery is generally recommended for definitive treatment. PASH tends to have a well-defined capsule, and complete excision with clear margins is important to prevent recurrence. In cases of diffuse PASH mastectomy may be required to achieve adequate margins. Non-surgical options  include expectant management of the lesion if  it is small and malignancy has been excluded. An impressive response of PASH to tamoxifen has been also reported. PASH often grows over time and can recur locally. The recurrence rates range from 15% to 22%. PASH is a benign condition with good prognosis and there has been no report of distant metastases or death. However, long-term follow-up is recommended for all these patients. (http://smj.sma.org.sg/4903/4903cr7.pdf)

I hope this helps. Take care and keep us posted.