Imaging of pseudoangiomatous stromal hyperplasia of the breast

ABSTRACT

Rare benign breast lesion that commonly affects premenopausal women. It is a myofibroblastsproliferation around optically empty slots giving a false appearance of vascular network of its name [pseudoangiomatous] hyperplasia where there is absolutely no vascular injury. It appears as a single mobile breast nodule, firm, usually unilateral and as a net opacity with regular contours and without microcalcifications.]V1. We present two lesions that were classified as malignant in the initial control by mammography, wich led to a needle biopsy.But no any histological sign of malignancy was shown. The diagnosis requires ultrasound-guided percutaneousbiopsy or stereotacticbiopsy for histological study. The false appearance of vascular network can mimic on a first reading a low-grade angiosarcoma. Then, immunohistochemistryis needed to demonstratemyofibroblastic origin. The resection must be complete with a long-term surveillance because of the risk of recurrence of up to 20% of cases when resection is not total. The diagnostic alternative is currently provided by the ultrasound guided percutaneous biopsy or stereotactic biopsy, which determines the nature of the lesion and rules out malignancy, such as angiosarcoma, in order to avoid unnecessary surgical biopsies