PASH surrounding malignant breast tumor

PS73 Member Posts: 171
edited October 2017 in Just Diagnosed

Good evening,

 I was recently diagnosed with breast cancer.  My pathology consists of PASH and cancer.  I have been told that this is rare as the PASH is surrounding the cancer.  I am wondering if this is bad because of PASH's rapid cell division or if it is indifferent.  Im ER+ - the tumor is 2cm and my bone and ct scans were clear.  Is the 2cm the cancer and the pash? I  haven't received the BRCA back or the HER2. I was told this is a grade 3.I have a burning sensation in my right breast from all areas around the tumor including above, the nipple, in the middle of my two breasts and also under my armpit.

 Two months ago, I stopeed getting my period.  I went to my obgyn and he prescribed an ultrasound.  They day before going back for my results I found my lump myself.  I swear it was not there before.  My dr gave me my results of my ovarian ultrasound indicating that I had a 4.5 cm cyst on my ovary.  This will go away and he prescribed me progesterone. Twelve days later I got my menses.  He prescribed a breast ultrasound and after al of the tests and one benign path and then a bad mri along with another four biopsies, I have breast cancer. (I had the lump before the progesterone) however post scan (2 weeks later) showed another cyst on my ovary.  Im due for my period tomorrow however i feel just like I did the last cycle.  It took me 54 days to get my period prior to my last cycle. 

Im 35 and Ill be getting a lumpectomy at the end of this week. I start chemo in seven weeks and am concerned that with all of my issues of not menstruating, I will not be able to ovulate to have my eggs taken out to fertilize and freeze as embryos..  I have been regular for years -every 28 days and I have not been on birth control for ten years.  My mother took progesterone while she was pregnant with me thirty five years ago however Im told this is not the issue however Im putting this in for statistical reasons.

Is there something there?  Ive heard from two drs that my ovulation and my pash/bc are not linked.  How can this be??  They are both reproductive organs.  Could you explain why the PASH and bc mix is so rare and also if you can assist and tell me if the pash is protecting my body from the cancer or is making the cancer spread.  Im not sure if Im grade 3 because of the PASH or the cancer.

 Please advise, this is really concerning.  Im to be married in eight weeks and my fiance and I want(ed) to have kids straight away.  Im nervous about the chemo and about pretty much everything.  Please note that there is absolutely no history of breast cancer in my family.

Thank you for taking the time to read this and help me to understand.


  • AnneW
    AnneW Member Posts: 612
    edited May 2009

    I'm bumping this up in hopes someone who knows something about PASH will speak up.

    I do want to give you some support for all you've been through and will be going through. Many women have babies after cancer treatment. Check out and you'll find a wealth of support and info for your age group.

    I hope you can find some good research on these issues that concern you.

    And best of luck with the wedding!


  • glostagirl
    glostagirl Member Posts: 93
    edited May 2009
    I found several on-line descriptions of PASH.  Most were written for medical professionals and very difficult to understand with the exception of the following: 


    Pseudoangiomatous Stromal Hyperplasia of the Breast
    Pseudoangiomatous stromal hyperplasia (PASH) is a benign myofibroblastic proliferation of nonspecialized mammary stroma. Its clinicopathologic spectrum ranges from incidental, microscopic foci to clinically and mammographically evident breast masses [98]. Originally, hormonal stimulation (particularly with progesterone) was suggested in the etiology of PASH, on the basis of observations that this disease is most frequently seen in premenopausal women or in elderly women taking hormone-replacement therapy, and because similar histologic findings are seen in normal mammary stroma during the luteal phase of the menstrual cycle. However, thelesion has since been found in men and in women not taking hormone therapy, and only a small percentage of PASH cases are positive for estrogen receptors or for progesterone receptors [9899].

    Clinically, rare cases of PASH present as a well-circumscribed, dense, rubbery mass mimicking a fibroadenoma or a phyllodes tumor. Both the mammographic and sonographic features in PASH are nonspecific, so biopsy of these lesions is necessary to exclude a malignancy [99100].

    On gross examination, PASH is usually a well-demarcated mass with a smooth external surface. The cut surface consists of homogeneous white and rubbery tissue. Histologically, a complex network of anastomosing slit-like spaces within a densely collagenous stroma characterizes PASH. The histologic appearance may cause confusion with mammary angiosarcoma, so immunohistochemical vascular markers are used for distinction. Immunohistochemically, the bland spindle cells that line these spaces are strongly positive for vimentin and CD34 and negative for cytokeratin and factor VIII.

    The recommended treatment for PASH is wide local excision. Although PASH can recur, patient prognosis is good [98].

    I hope you find this helpful.   It seems that rare cases of this can be malignant, hopefully the lumpectomy will take care of the problem for you.

    I've never heard of PASH which is what made me look it up on-line.  Also, if you do a search of this discussion board, you will find quite a few postings on PASH. 

    Good luck  

  • PS73
    PS73 Member Posts: 171
    edited May 2009

    glostagirl and annew, thank you for the information.

     The tumor inside is malignant however the pash is surrounding it, as you mentioned it is rare.  My dr told me I will need chemo and radiation bc of the malignancy.  I go for lumpectomy end of the week so Im hoping they can advise more about what I have.  Its ER+, that is all I know right now.  Waiting for HER2 and BRCA. 

    Again, thank you!

  • acressle
    acressle Member Posts: 1
    edited October 2009


    I was recently diagnosed with PASH and have had the tumor removed. I am concerned as when I first ovulated after the surgery I still felt the tingle/sensation in the breast and some anxiety in the chest. I also found a small lump close to my right hip which has not been diagnosed any further. I would definetly correlate the PASH with ovulation. I will be making further Dr.'s appt.'s to investigate further as I feel the PASH will be right back :(  I do feel that the PASH is hormone related and that my hormones have not been right for quite some time. I have even looked into. Bioidentical hormones. I have some follow up appt.'s right now but may foot the bill to have my hormones checked out more extensively. Good luck to you and remember you are your own advocate keep up the research.

  • PS73
    PS73 Member Posts: 171
    edited October 2009

    Dear Acressle, I haven't seen this thread in a long time, it seems like years ago that I wrote this.  So much information, surgery, chemo and just plain life has happened since then and I am certainly a different person now. I never coorelated the PASH w/ hormones before.  ... that is an interesting theory and does seem to make a lot of sense.  Let me know what your doctor says about it.  Just to be clear, did they find cancer w/ the pash or just pash when they took the tumor out?   Note that the reason why my surgeon went back in for another biopsy was because she felt that pash is usually mixed in w/ cancer (but not all the time so just check to confirm w/ the surgeon that they got everything out and its benign :).  Also, the tingling could be from the nerves regenerating at the surgery site, I had a lot of that and still do to this day.  Have you had a breast mri/mammo on both breasts?  Im sure you are fine but stay on top of your drs, as you said to me, you are your own advocate!  

    also, bhrt is usually paid upfront for the visits and you can reimburse to your insurance per case by case; i consider the money lost and am happy if i get it back.  get your mri and mammo first before doing any hormones.  I took the test but Im not doing anything until Im off of chemo.

    Hang in there, hopefully I didn't scare you too much :) Let me know how it goes!

  • pabarrn
    pabarrn Member Posts: 1
    edited June 2010

    I was recently had a core needle bx and was dx with a PASH.  A mass was found on U/S and not mamography. I was told to wait 6 months and repeat my ultrasound.  Everything I have read says that the entire PASH should be excised.  Any suggeastions as to what I should do?

  • jeanie51
    jeanie51 Member Posts: 1
    edited May 2012

    I was just given this same diagnosis this week.  The patient navigator told me all I needed was a followup in 6 months, but my OB/GYNE said I should see a breast surgeon because it was her understanding that an excision of the PASH  tumor was the protocol.  I have an appointment with the surgeon this week and am very confused and worried.  Does anyone have any advice?

  • cinnamonsmiles
    cinnamonsmiles Member Posts: 67
    edited May 2012

    I was diagnosed with PASH in 2011. My surgeon told me that the only treatment is surgical removal. She said that PASH is benign but can continue to grow and grow and grow...

    Mine was found on the non-cancerous breast after my BMX. It did show up on a pre-surgical MRI.

    Here are some websites about it that I googled:

  • Neverforgetme1986
    Neverforgetme1986 Member Posts: 2
    edited October 2017

    I was diagnosed with pash at 26 along with fibroadenoma and usual Ductal Hyperplasia and adh... my left breast now has a tumor 3 fingers wide and very well felt under the breast... it’s been 5 yrs since my diagnosis and I’m just now working on trying to eat this one looked at 😒. I am so scared...

  • MTwoman
    MTwoman Member Posts: 228
    edited October 2017

    sorry that you're here and worried Neverforgetme. this thread hasn't been active in over 5 years, so you might not get any responses. If you haven't already, maybe you want to start a new thread in the "not diagnosed but worried", "benign breast conditions" or "high risk for bc" forums? Good luck!