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PASH - Pseudoangiomatous stromal hyperplasia

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gillianinnh
gillianinnh Member Posts: 3

Hello Everyone,

I was just diagnosed with PASH. My dr had found a lump originally thought to be a 5.5cm fibroadenoma. I had a biopsy and it came back PASH and closer to 4.5cm. There are also two other cysts in the same breast 1.2cm and 8.3cm (or maybe 8.3mm as doc seems to think the 8cm is a typo.) I spoke with a general surgeon and she wants to remove the PASH mass. I go for a consult with a breast specialist on Thursday (12/20) I've noticed that there is not a lot of info out there on PASH. I am hoping to find some BTDT support here. 

If there are any women out there who've been through the PASH experience and have any useful advice or resources I'd greatly appreciate it.

Thanks

Gillian

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  • marie5890
    marie5890 Member Posts: 111
    edited December 2012
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    Hello Gillian and welcome.

    I was Dx-ed with PASH about 2 years ago. Normal protocal is to remove it, but you dont "have" to. I didnt.

    Some PASH can grow bigger. SOme when removed can grow back, and others can just disappear on their own. I chose to just leave mine (it was deep and close to the chest wall and wasnt bothering me. Found it thru my annual mammo).

    Talk with the BS. Look at your options. 

    There really isnt much out there on PASH to be honest, but it is a B9 condition and more often than not when it is found, it's an incidental finding.

    Good Luck

  • gillianinnh
    gillianinnh Member Posts: 3
    edited December 2012
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    Thanks Marie! Can I ask, how big your PASH mass is? And is it still growning? Mine is large enough that it is visibly noticable. This is partially due to the fact that I am lucky to fill an A cup on a good day! Laughing  Also, did anyone discuss the issue around the PASH blocking the view of other tumors or the potential for it actually being angiosarcoma? Both of these considerations came up in conversation with the my first surgical consult who wanted to remove it. 

    Thanks!

  • marie5890
    marie5890 Member Posts: 111
    edited December 2012
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    No mine is not growing. Infact it's pretty much gone. It was about 1cm x .9cm. 

    No discussion was made about it blocking anything. It really was right up against the chest wall. And my breast tissue isnt nearly as dense as it was when I was younger.

    I really felt good about just letting it be and my BS was just as comfortable and I trusted him a great deal (one of the best in my state). 

    I have since had my annuals and all is A-Okay----It really is a personal choice 

  • marie5890
    marie5890 Member Posts: 111
    edited December 2012
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    (Cut and pasting more info for you. Noting for you as well that angiosarcomas are very rare. 0.04% of ALL breast cancers. Meaning extremely rare)

    Pseudoangiomatous stromal hyperplasia (PASH) is a type of benign breast lesion that occurs as a single palpable mass or a dense region on a mammogram

    The masses observed in individuals with PASH are benign (non-cancerous) and require diagnosis only to distinguish them from cancerous (malignant) lesions.  It may be mistaken for angiosarcoma; however, the breast lesions caused by angiosarcoma are different than those seen in PASH

    The size of PASH lesions range from incidental microscopic findings to breast masses that are palpable or evident on a mammogram. Masses are usually large (5-6 cm in diameter), with reported diameters ranging from 1 to 12 cm.  The masses may grow over time

    PASH most commonly affects premenopausal women. The age range of people diagnosed with PASH is 14-67 years; however, most individuals are diagnosed in their late thirties or forties

    Surgical removal of the PASH lesions has been performed in some individuals.  A wide margin around the mass may be removed to prevent recurrence. Although PASH lesions often grow over time and may recur, they are neither associated with malignancy (cancer) nor considered to be premalignant (pre-cancerous).[1]  According to the medical text, CONN's Current Therapy 2007, approximately 7 percent of people experience a recurrence of PASH.[2]

  • maiyen
    maiyen Member Posts: 22
    edited December 2012
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    Hi gillianinnh,

    My path report in April came back with PASH and as it's already been noted, it is benign but there is not much out there about it or there are conflicting treatments.  I am currently on a 2 year watch and wait plan with 6 month follow ups to monitor the stability of my large mass (I also have a small lump, but it hasn't been biopsied).  My BS seems ok with this treatment, but I have read from several sources online, including Johns Hopkins Ask An Expert program, that recommends excisional biopsy for PASH.  I'm not sure why the difference of opinion?  My mass is 4.6 cm x 4.7 cm and I have asked if the entire tumor is PASH or just some of the cells, but we don't know since I've only had a core biopsy.  

    I'm sorry that I don't have more info for you since I'm kind of in limbo about what to do myself.  However, I would recommend checking out the Johns Hopkins site and reading some of their breast Q&A, you might find some things about PASH over there.  You can even ask your own question and one of their breast specialists will answer it.  Lillie Shockney oversees that program.  

    Please keep us updated...would love to know what you decide!

  • Atrue
    Atrue Member Posts: 1
    edited December 2012
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    I was diagnosed with a lesion from my mammogram in July 2012 and sent to a hospital for a sonogram with a diagnosis of "FIBROADENOMA".  I was "TOLD" that it was common, NONE CANCEROUS, and to come back in a year if it did not grow.  Low and behold a month later it GREW and I was in excrutiating PAIN on a friday that lead me to my OG/GYN first thing that Monday morning.  She referred me immediately to my now BREAST SURGEON who did an in office biospy that turned out to be "NONE CANCEROUS -PASH". 

    Well I went into surgery to have it removed on Nov 28, 2012 and low and behold the pathology report came back CANCEROUS with CANCER STAGE "0" GRADE 3 (DCIS) DUCTLE CARCINOMA IN-SITU BREAST CANCER w/ PASH. Yes, I was in COMPLETE shock and was given the choice of radiation with the possibility of my CANCER coming back later or a MASTECTOMY with a lesser chance of it coming back.

    I chose the MASTECTOMY my mother had CANCER two years ago and my father DIED from pancreatic cancer as well two years ago but also due to the sisters on both of my parents side of the family have and had BREAST CANCER in which my father's sister DIED from STAGE 4 breast cancer.  

    I then went for my MRI before Christmas and THANK GOD it didn't spread but now I have decided to prayerfully get a bilateral mastectomy with IMMEDIATE RECONSTRUCTION.  I have an appointment this week with the plastic surgeon to discuss my reconstruction options for my upcoming surgery.  He will discuss the surgery date with my BR next week to inform me of my surgery.  

    I will keep everyone updated on my outcome due to "PASH" is SUPPOSED to be a VERY RARE NONE CANCEROUS TUMOR but would suggest to EVERYONE now due to my outcome of CANCER to have it REMOVED as soon as possible because I was told by my BR that "IF" I would have WAITED that year as the radiologist informed me to do at the hospital when I was diagnosed with "FIBROADENOMA" that my DCIS CANCER could have spread throughout my body from my  "FIBROADENOMA" that was PAINFUL & GREW to my now NONE CANCEROUS RARE PASH that "IS" CANCEROUS!  

  • house3064
    house3064 Member Posts: 1
    edited January 2013
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    Dear Gillian,



    Thank you for posting this. Yesterday, I too was diagnosed with PASH. My tumor is 6 cm in size. I had my first mammogram two weeks ago, which then resulted in a digital mammogram, ultrasound and then core needle biopsy. Yesterday, I was relieved it was B9, but a bit concerned by the lack of information to help me make an educated decision.



    When I asked what my options were, I was told we could watch it or remove it. My doctor said since it is a rare diagnosis he wanted to personally stop by the breast surgeon's office to discuss my case. So, I am waiting once again to hear back.



    Everything I have read confirms what Marie has posted. However, it also indicates that each situation is different. Some have tumors that grow rapidly, while others stay the same size or smaller. Others have pain, while some do not. What I have learned is that we need to look at our individual case and determine what is best for us. In my case, I am leaning towards removing it.



    I will keep you posted. Hopefully you will do the same. It is a bit comforting to know we are facing the same thing at the same time.



    Best of luck,

    Susan

  • KZC13
    KZC13 Member Posts: 1
    edited January 2013
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    I was diagnosed with PASH last April. My tumor was about 6 cm and seemed to be growing. My GYN and breast surgeon recommended having it removed. I had a lumpectomy last June and was relieved that it was. I was not comfortable leaving it there to continue growing.

    Karen

  • meme322
    meme322 Member Posts: 1
    edited January 2013
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    Hello, I just wondered how your appt. with the surgeon went. I was diagnosed in Dec. as well, and have surgery in January. My breast was initially painful and swollen, and red, and so I went to my internist. Within 18 hours I had had a mammogram, ultrasound, and needle biopsy. Its no longer painful or swollen, probably just one of my 1000 cysts acting up, but I am looking forward to having the PASH tumor removed! (It feels about acorn sized?)

  • marie5890
    marie5890 Member Posts: 111
    edited January 2013
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    Welcome ladies. :)

    Having a PASH tumor removed is the usual protocol. So if you are having yours removed, know that is the most common option.

    To address Atrue's post, PASH is not cancer. What seems to be her case is what can happen with women who are Dx-ed with BC (in her case DCIS grade 3 with incidental finding of PASH) does happen. So having a lesion removed is always a viable option. 

    But the PASH itself is Not cancer. It's another finding that was found with the cancer(in her case DCIS, a non-invasive form). 

  • gillianinnh
    gillianinnh Member Posts: 3
    edited January 2013
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    Hello All,

    Sorry to go dark on everyone. Between the holidays and wanting to stay buried in work to keep my mind busy I haven't been back here in a while. The BS was in agreement that the PASH tumor should be removed. The surgery (which they are refering to sometimes as a lumpectomy and other times as an excisional biopsy) is schedule for 1/17/2013. The breast surgeon was able to give much more specific information as to why she would reccommend the removal. Her main reasons were the fact that it clearly had grown in the last few months, the fact that if it grew much bigger the lumpectomy becomes more complex and finally she just wasn't comfortable with the margin of error. She stated that given the size there was just simply a greater chance that the core needle biopsy had missed something. The removal of the lump will address all of those issues giving greater piece of mind and address the situation before it becomes more complex than necessary.  I'll post an update when things are done so that if others come along looking for info in the future hopefully they can find it.  Smile  

    Best of luck and thanks to all that posted. Hoping for happy outcomes for everyone.

  • ALF124
    ALF124 Member Posts: 2
    edited April 2013
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    Hi EVeryone,

    I have just found out my results from my core biopsy yesterday that i have PASH - benign. My doctor said just to get it checked again in a year's time. If anything changes to the lump i should go to my local gp etc. I am now reading everyone's different stories and don't know what to do. Should I look into getting it removed? I am really confused.

  • Downtowngirl33
    Downtowngirl33 Member Posts: 2
    edited April 2013
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    Hi ALF124. I saw the breast surgeon yesterday (the pathology report says I have PASH, PAM and CCL). She isn't concerned at all.. Says I have busy breasts which is common for my age (43). She is going to have my biopsies re-read by a pathologist who specializes in breasts. She agreed to let me get a MRI but I kind of had to talk her into it. As far as the PASH goes her plan is to leave it in unless it gets bigger

  • marie5890
    marie5890 Member Posts: 111
    edited April 2013
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    ALF,

    I too had PASH. Decided not to do anything about it unless it caused me discomfort. It never did and it went away on it's own (which can happen with PASH)

    Having it removed is standard protocal, but it's not the only option. Have it removed if you want, or wait a bit and see if it grows (or even disappears).

    You dont need to make a decision on PASH, "right now"

    But do what is best for you

  • ALF124
    ALF124 Member Posts: 2
    edited April 2013
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    Thank you Marie! I appreciate your feedback..

  • spanky
    spanky Member Posts: 5
    edited April 2013
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    Hey Ladies, I am 31 and noticed lactation (have not had kids), increased breast size (B to D), i had a history of pituatry tumour but this was ruled out. I started getting pain in my right breast and was diagnosed with a small (2.1cm) PASH. The PASH & lactation were not related. 

    If it wasn't causing me any pain I would have left it, but chose to have it removed 7 weeks ago.

    Everything was going fine, but this week the pain has come back. I am being checked in a few days to see if it has come back.

    Does anyone know anything about the recurrance of PASH?? I haven't been able to find anything online.

    Gil how are you doing??

  • melissadallas
    melissadallas Member Posts: 929
    edited April 2013
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    Yes, PASH does tend to recur if not completely excised.

  • marie5890
    marie5890 Member Posts: 111
    edited April 2013
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    PASH may or may not  grow or reacurre. It really depends. Sometimes they disappear on their own. Mine did. There is not clear  pattern when it comes to  PASH.

    Nov. '10 Mammo,U/S, MRI showed suspicious 9mm x15mm mass . Jan '11 Biopsy Dx-ed a PASH tumor (rare, but benign tumor)....All I ask is for peace and serenity to the depths of my soul. Makes the rest of life more live-able.

  • SueInMN
    SueInMN Member Posts: 1
    edited April 2013
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    I was diagnozed with PASH about 4 or 5 years ago.  All they had me do was come in for a 6 month followup ultrasound and it has gone away and so far not returned.  It was actually not even suggested that I have it removed; until reading this thread I didn't even know that removal might be standard.   I've had biopsies for other things since then, but no issues with PASH again. 

  • spanky
    spanky Member Posts: 5
    edited April 2013
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    Went back to the dr today and the dr said the pain could be part of the healing process. Waiting 3 months and if the pain is still there then will have an MRI to see if PASH has returned.

  • vollmer621
    vollmer621 Member Posts: 4
    edited April 2013
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    Hi Everyone!  I'm new to the site.  Just received a call from my bs today and was told that I have PASH.  Went in for a routine mamo a couple of weeks ago and was told that a mass that I had for a couple years had grown and that they wanted to biopsy it to make sure all was ok.  Got the ok about a week and 1/2 ago that it was ok.  Tonight I got a call from the bs and she told me that it's PASH and she wants me to have it removed.  I don't have the exact dimensions of the mass but she said that it's a little smaller than a quarter and the best thing to do is have it removed as it could grow.  I've been looking some things up and I saw that some people have asked about birth control pills possibly be a cause - does anyone know about this?  Also what is recovery like after a lumpectomy?  We have a family trip planned for the first week of July and i was wondering if I should have the procedure done after that.

    Any words of wisdom would be so welcome!  Thanks soooo much!

  • melissadallas
    melissadallas Member Posts: 929
    edited April 2013
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    Hi Vollmer,



    Estrogen fuels lots of breast conditions so you should ask the doc about that.



    You'll probably feel almost completely back to normal within a week or ten days. Really, I was only sore enough to matter for two or three. You won't need much healing time before your trip.

  • vollmer621
    vollmer621 Member Posts: 4
    edited April 2013
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    Thanks Melissa!!

  • marie5890
    marie5890 Member Posts: 111
    edited April 2013
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    Vollmer, hope these links are helpful. I was in my 20's when I was on the pill, but only for about 6 years. My PASH was found 2 years ago at the age of 46. Hardly doubt the pill was associated in my case, but very possible peri-menopause

    http://www.ncbi.nlm.nih.gov/pubmed/7872425

    http://www.breast-cancer.ca/type/pseudoangiomatous-stromal-breast-hyperplasia.htm

  • vollmer621
    vollmer621 Member Posts: 4
    edited April 2013
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    Hi Marie - thanks for the articles!  I was on the pill when I was in my 20s.  Went off to have kids.  Now I'm 45 and back on b/c my period was wo wacky.  Will ask my bs what she thinks about it.

    Did you have surgery to have your PASH removed?

    Thx

  • argynis
    argynis Member Posts: 22
    edited April 2013
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    I was diagnosed with PASH when I found my lump in December - they must have missed it when they did the biopsy.

    It kept growing and when they took it out in February I got the cancer diagnosis :(

  • Downtowngirl33
    Downtowngirl33 Member Posts: 2
    edited April 2013
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    Hi argynnis. Did the PASH become malignant or was it found in addition to a malignancy? Wishing you well in your recovery

  • cinnamonsmiles
    cinnamonsmiles Member Posts: 67
    edited April 2013
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    Downtowngirl33: PASH is a benign condition. It can not become malignant.

  • argynis
    argynis Member Posts: 22
    edited April 2013
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    Downtowngirl33: I think the PASH was never really there and it was a wrong diagnosis. They found no PASH in the cancerous tumor when they did the lumpectomy and also no signs of PASH in the remaining tissue when I had the mastectomy.

  • marie5890
    marie5890 Member Posts: 111
    edited April 2013
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    Vollmer,

    No I didnt have mine removed. Infact it went a way on it's own, which is something PASH can do.