Answer to the last #DiagnosticDilemma
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The answer to the last Diagnostic Dilemma (A 24-year-old woman developed sore, painful, bilateral, asymmetrical breast masses over a 3-month period. She had an etonogestrel—progestogen only—contraceptive implant put in 6 months earlier. ) is C) Pseudoangiomatous stromal hyperplasia

On examination, the patient’s breasts were asymmetrical; both were erythematous, tender, and had focal, palpable, mobile masses. The skin of both breasts had a peau d’orange pattern.Given the skin findings, the rapid growth, and the large, irregular, and heterogeneous nature of the masses, radiologist assigned a Breast Imaging-Reporting and Data System category of 5—indicating that considered the lesion highly suspicious of malignancy.

Histopathological examination of samples taken from both breasts, using core-needle biopsies, showed prominent pseudoangiomatous stromal hyperplasia (PASH) and mammary hamartomas. Removed the implant, and 1 week later, the patient reported significant reduction in breast size, pain, pressure, and erythema. She is planning to have both masses excised and oncoplastic reconstructive surgery carried out. PASH masses can resemble breast cancer both on examination and at imaging, and tissue sampling is imperative for diagnosis. PASH is a hormone-sensitive process and rapid progression can occur with sudden hormonal changes, which given the timeline believe was the case with patient—the contraceptive implant being the source of the excess hormone.

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Source: The Lancet


Dr. A●●●●●a B●●●●●●●j and 2 other likes this
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Dr. R●●●●a M●●●i
Dr. R●●●●a M●●●i Obstetrics and Gynaecology
I had a similar case in pregnancy but the biopsy did not reveal this finding Her breast size kept increasing .She became better after her delivery everything subsided.
Jul 5, 2020Like