Biopsy showed PASH

Im happy to see others have had this diagnosis of pash, my radiologist that saw me today had no idea what I was telling him when I explained I had a pash tumor removed two years ago. Developed bad pain in my chest nine months ago that started to throb and came and went kind of when my hormones we're up. Today I had another mammogram and ultrasound and they said there were two lumps one by my old incision area on the armpit side of my left breast and one pea size near my nipple. I have doing nothing but crying most of the day with no definitive explanation as the radiologist just didn't know what it was by the looks. Says that "typically". He can tell if it's malignant but didn't know what mine was. Just panicking I'm only 37 I'd rather have it be another pash mass but who knows what it is

Hi Chemistry91. How is your recovery going? They have never mentioned a "partial mastectomy" to me. I didn't even know that can be an option. I will have to research that and educate myself. I hope you are doing well with your recovery. Carrissac, I agree with Chemistry91that you would benefit from a second opinion. I drive 2 hours to see a breast specialist and it is worth it. Hopefully you can find a more specialized physician in your area who has some experience with PASH. It definitely can confuse a radiologist who is not very familiar with it. I hope you are able to get better answers soon. I know the waiting and not knowing can be hard.

Hi marie5890,

How did your PASH tumor go away? Did you do anything different? lose weight, exercise, eat differently? I'm just curious, it looks like some PASH grows bigger and some disappears on its own.

thank you in advance for your response,

I am doing pretty well. Thanks for asking! Still really sore but they tell me this is normal because of how much tissue they had to take from my left breast.

My PASH had gotten significantly larger, from about 2 cm in length to 7 cm so it was time for it to come out.

They told me it doesn’t increase my risk for breast cancer and they are unsure of the cause. They did say that PASH in tumor form like I had is quite rare. Reading the pathology report was interesting because there was definitely a mass there and it was different in color and density than the surrounding tissue.

I have a science background and have tried to research PASH but it is so difficult to find recent sources. My doctor co-authored a paper but even that was written in 2014.

I was unaware that PASH can disappear on its own. I am curious about that and hope I didn’t make the wrong decision in having it removed. Hoping it doesn’t come back because I am nervous about how they would treat it.

I agree that having it removed was the right choice in your case. It's so crazy that they don't know what causes it and it can be so different from one person to the next. I tried to research it also when I was first diagnosed to try to educate myself, but there is so little out there. I need to request the pathology report from my last surgery, I'm curious about it. I have been told that if I keep needing surgeries that eventually I may need acomplete mastectomy. I hope it doesn't come to that.

Chemistry glad everything went well for you. I think you did the right thing by having your PASH tumor removed. I also had a PASH tumor and after having it removed ADH was found inside of the tumor. My breast surgeon said she’s glad we removed it.

Hi ml8. I'm not sure if you were asking a specific person...but in my case I just continue to see a specialist every six months. I have not had another mass so far, so no more surgey. I haven't had any pain the last few months, so I hope this is a good sign that it is slowing down. I hope you find a good doctor and get some answers. It can be very frustrating and confusing at times. I wish you the best.

Did you get genetic screening?  Do you have any close relatives who had breast cancer? Do you have dense breast tissue? All of these factors affect how closely you should screen and what you might consider doing.   I have PASH, I have CHK2 gene mutation and my mom had breast cancer when she was 40.  I also have extremely dense breasts which makes it hard to find cancer during screening.  I went to three doctors.  One doctor told me I need to get the PASH surgically removed especially since it is large (1 1/2 inches) and growing.  I also detected a lump next to it which is probably also PASH (I have an appointment for a mammogram and ultrasound next week).  That doctor suggested a prophylactic double mastectomy (I have had 5 biopsies and I am 56).  She said I will be lopsided after a lumpectomy so I might consider prophylactic double mastectomy surgery which includes reconstruction.  Two other doctors told me to just watch it (I saw them before I found the new lump).  A genetic counselor can help you quantify your chances of getting cancer compared to the normal population.  If you don't have genetic mutation, dense breasts or family history, you might consider just monitoring yearly or twice a year (I get an MRI 6 months after my mammograms + ultrasounds).

I had PASH found on biopsy with my DCIS...... I had a mastectomy and nobody mentioned it ever again. But I came across my pathology notes and seems like I was not too many degrees away from having developed invasive cancer (large span, palpable lump, some central necrosis) It makes me worry more about possible recurrences, if you add in PASH, just more weird cellular activity in my body. I was 35, also hormone positive. I go to an educational hospital and not all doctors are knowledgeable and I got "distracted" recovering from mastectomy and never brought it up again. I hope the pathologists were thorough.

Hi, ladies. I'm the concerned mother of a 22 year old who was diagnosed with PASH last year at 21. She has been on and off the pill since her mid-teens for polycystic ovary syndrome, and about a month before finding the lump she had taken the morning-after pill. I don't know if her PASH is hormone related. She saw a breast specialist over Thanksgiving and again over Xmas when she was home from college because she thinks it's getting bigger. He is urging watchful waiting. If the lump is enlarging, I fear she may need surgery--although she won't be back in NJ till late June. Right now, I plan to schedule a second opinion appointment with a specialist at Sloan Kettering here in NJ, but I'm a little scared by all the talk of mastectomy as a result of PASH. Please help put my mind at ease. There is no history of breast cancer in our immediate family, and I do not have the BRCA gene. Thanks.

I had found a lump 2.5 years ago in my right breast and after going to my GP, I began mammograms every 6 months. After 2 years of this and feeling like I was on an emotional roller coaster, I went to a breast speciality clinic for a CESM and ultrasound. I ended up having 3 core needle biopsies in different areas. The lump that I had found came back as PASH and atypical ductal hyperplasia.

Since the lump had grown so much over the past 2 years, I had it removed and was shocked when I went for my post op and was told I had DCIS with microinvasion component and it is ER+. Still reeling, I have my oncology appointment tomorrow and genetic counseling appt on a Wednesday.

I don’t even know what to expect. I’ve been driving myself nutty with worry about it not being seen on any screening and of there’s more cancer hiding since I have very dense breasts with PASH in both!

Just diagnosed on core needle biopsy with PASH, and this is in my right breast with development over less than 8 months (exact timing between MRI screenings). I've been well-monitored since I had high-grade micropapillary DCIS in left breast less than three years ago so the doctors and I can pretty much know exactly when this PASH became noticeable on mammos and MRIs. I also have extremely dense breast tissue in both breasts. I had a lumpectomy for the left breast DCIS and then 6 weeks of whole breast radiation therapy (but no chemo, so thankful!). Now this panic because of PASH in the right breast, which the doctors thought was infiltrating ductal carcinoma.

And all this between the ages of 41-44 (as of next month). I have a few questions specifically for those who have had a breast cancer diagnosis either before or after your PASH diagnosis:

1. Did you have clinical symptoms? I had bloody nipple discharge with both the DCIS and now with the PASH.

2. On core needle biopsy for PASH, my focal area was only 4 mm (mm...not cm). I'm having a lot of pain at various points during menstrual cycles. Did any of you notice sudden peau d'orange skin changes (orange peel skin) or that your PASH boob got darker in skin color? I'm white (Caucasian) and my PASH breast turns a very dark brownish color like a deep tan sometimes that doesn't seem tied to menstruation. Anyone else having weird skin color changes that last a few days and then quickly fade back to normal?

3. Is your PASH just in one breast (unilateral) or both (bilateral)? And, if bilateral or both breasts, was the PASH present in both breasts at the same time or did one breast develop PASH later than the other breast?

There is definitely not enough research done on this benign disease. I'm scared and angry...didn't want to be back at oncologist and surgeon offices. My oncologist and breast surgeon has given me two options thus far: 1. Wait six months and redo the mammos, ultrasound, MRI to see if anything has changed; or, 2. Another lumpectomy, also known as wide local excision, as a "just to be sure" and to help relieve some of the pain the PASH is causing. Both are not satisfactory for me. What are the qualifications for mastectomy?

Just so frustrated with boobs!

If you are not having symptoms then I would recommend waiting. I had one removed and it grew back.