{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:59:37Z","timestamp":1789415977513,"version":"build-2803163510"},"reference-count":20,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T00:00:00Z","timestamp":1758326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction: Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast lesion characterized by stromal myofibroblast proliferation forming slit-like pseudoangiomatous spaces. Although most frequently diagnosed in premenopausal women, it has also been reported in adolescent girls, where it may present as a rapidly enlarging mass that mimics fibroadenoma or phyllodes tumor. The pathogenesis is thought to be hormonally influenced, particularly by progesterone, with a possible role for estrogen. Case Report: We report the case of a 14-year-old girl who presented with a painless, rapidly growing mass in the left breast, first noticed approximately six months earlier. Clinical examination revealed a mobile lesion about 10 cm in diameter without skin changes, lymphadenopathy, or nipple discharge. Ultrasound and MRI demonstrated a large, well-circumscribed solid tumor (10.4 \u00d7 11.2 \u00d7 4.2 cm3) displacing normal breast tissue but without infiltration; both were classified as BI-RADS 4. Given the tumor size, diagnostic uncertainty, and potential risk of a non-representative core needle biopsy, a decision was made to proceed with primary radical excision. The mass was completely removed with preservation of the glandular tissue. Histopathology confirmed PASH, described macroscopically as a solid, gray\u2013yellow, encapsulated tumor and microscopically as slit-like spaces lined by spindle cells (CD34+, CD31\u2013). Postoperatively, the breast gradually regained symmetry with the contralateral side, and at 14 months of follow-up, no recurrence was observed. Conclusions: PASH, although benign, may present as a large breast tumor in adolescents and clinically mimic both benign and malignant lesions. Histological evaluation based on an adequately performed biopsy is crucial for accurate diagnosis. Complete excision with capsule preservation is recommended to minimize the risk of recurrence. In adolescents, a watchful waiting approach after surgery may be beneficial, as breast tissue often remodels and regains symmetry spontaneously, reducing the need for reconstructive procedures. This case underscores the importance of individualized diagnostic and therapeutic strategies in managing rare benign breast lesions in pediatric patients.<\/jats:p>","DOI":"10.3390\/diagnostics15182395","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T10:05:17Z","timestamp":1758535517000},"page":"2395","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic and Therapeutic Challenges in Pseudoangiomatous Stromal Hyperplasia (PASH) of the Breast in a 14-Year-Old Girl: A Case-Based Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4714-6501","authenticated-orcid":false,"given":"Patrycja","family":"Sosnowska-Sienkiewicz","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Medical University of Warsaw, \u017bwirki i Wigury 63A Street, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Przemys\u0142aw","family":"Ma\u0144kowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, ul. Fredry 10, 61-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2332-2750","authenticated-orcid":false,"given":"Danuta","family":"Januszkiewicz-Lewandowska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, ul. Fredry 10, 61-701 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bouche, C., Wolf, T., Buttignol, M., and Mathelin, C. (2025). Pseudoangiomatous Hyperplasia of Mammary Stroma: Insights from Two Cases, Data Update and Management Algorithm. Eur. J. Breast Health, Online ahead of print.","DOI":"10.4274\/ejbh.galenos.2025.2025-3-8"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3269","DOI":"10.1245\/s10434-010-1170-5","article-title":"Pseudoangiomatous stromal hyperplasia and breast cancer risk","volume":"17","author":"Degnim","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.surg.2010.07.020","article-title":"Pseudoangiomatous stromal hyperplasia of the breast: A contemporary approach to its clinical and radiologic features and ideal management","volume":"148","author":"Gresik","year":"2010","journal-title":"Surgery"},{"key":"ref_4","first-page":"1058","article-title":"Pseudoangiomatous Stromal Hyperplasia (PASH) in adolescence: A systematic review","volume":"1","author":"Pellini","year":"2018","journal-title":"World J. Surg. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.5604\/01.3001.0053.8610","article-title":"Tumoral pseudoangiomatous stromal hyperplasia (PASH) of the male breast: A systematic analysis","volume":"96","author":"Salati","year":"2023","journal-title":"Pol. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/j.1524-4741.2012.01230.x","article-title":"Pseudoangiomatous stromal hyperplasia (PASH) of the breast: A series of 24 patients","volume":"18","author":"Bowman","year":"2012","journal-title":"Breast J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sosnowska-Sienkiewicz, P., Januszkiewicz-Lewandowska, D., and Ma\u0144kowski, P. (2024). Przemys Benign and malignant breast lesions in children and adolescents\u2014Diagnostic and therapeutic approach. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1417050"},{"key":"ref_8","first-page":"e71900","article-title":"A Remarkable Presentation of Phyllodes Tumor with Pseudoangiomatous Stromal Hyperplasia","volume":"16","author":"Das","year":"2024","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"rjaa514","DOI":"10.1093\/jscr\/rjaa514","article-title":"The effect of hormones on an uncommon breast disorder pseudoangiomatous stromal hyperplasia: A case report and literature review","volume":"2020","author":"Hattingh","year":"2020","journal-title":"J. Surg. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1053\/j.sembd.2007.10.008","article-title":"Unusual benign breast lesions","volume":"10","author":"Kempf","year":"2007","journal-title":"Semin. Breast Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.5858\/2008-0686-RS.1","article-title":"Pseudoangiomatous stromal hyperplasia: An overview","volume":"134","author":"Virk","year":"2010","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1177\/1066896908320835","article-title":"Pseudoangiomatous Stromal Hyperplasia (PASH) of the breast with foci of morphologic malignancy: A case of PASH with malignant transformation?","volume":"18","author":"Nassar","year":"2010","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100617","DOI":"10.1016\/j.clinsp.2025.100617","article-title":"Phyllodes tumors of the breast: A comprehensive review of diagnosis, treatment, and follow-up","volume":"80","author":"Donato","year":"2025","journal-title":"Clinics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1046\/j.1524-4741.2001.07611.x","article-title":"Tamoxifen in the management of pseudoangiomatous stromal hyperplasia","volume":"7","author":"Pruthi","year":"2001","journal-title":"Breast J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1046\/j.1524-4741.2003.09426.x","article-title":"Pseudoangiomatous hyperplasia and response to tamoxifen therapy","volume":"9","author":"Seltzer","year":"2003","journal-title":"Breast J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.7863\/jum.2007.26.8.1101","article-title":"Rapidly enlarging tumoral pseudoangiomatous stromal hyperplasia in a 15-year-old patient: Distinguishing sonographic and magnetic resonance imaging findings and correlation with histologic findings","volume":"26","author":"Teh","year":"2007","journal-title":"J. Ultrasound Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1111\/pin.12786","article-title":"Atypical pseudoangiomatous stromal hyperplasia showing rapid growth of the breast: Report of a case","volume":"69","author":"Noda","year":"2019","journal-title":"Pathol. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"218","DOI":"10.5999\/aps.2016.43.2.218","article-title":"Pseudoangiomatous Stromal Hyperplasia Presenting as Rapidly Growing Bilateral Breast Enlargement Refractory to Surgical Excision","volume":"43","author":"Lee","year":"2016","journal-title":"Arch. Plast. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.jpag.2009.10.003","article-title":"Plastic Surgery and the adolescent breast: Preliminary patient counseling","volume":"23","author":"DeSilva","year":"2010","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"(2017). Committee on Adolescent Health Care Committee Opinion No. 686: Breast and Labial Surgery in Adolescents. Obstet. Gynecol., 129, e17\u2013e19.","DOI":"10.1097\/AOG.0000000000001862"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2395\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:17Z","timestamp":1760035577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,20]]},"references-count":20,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182395"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182395","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,20]]}}}