Rapidly growing unilateral pseudoangiomatous stromal hyperplasia in a 10-year-old girl: A case report and review of management strategies.
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RATIONALE: Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast condition characterized by collagen fiber-segmented, blood vessel-like clefts lined by spindle cells, lacking red blood cells. First described by Vuitch et al in 1986, PASH typically presents with benign imaging features and is often identified incidentally during investigations for other breast conditions. PATIENT CONCERNS: This case study documents a rare instance of unilateral breast PASH in a 10-year-old girl, which demonstrated rapid growth over a short period, necessitating surgical excision. The patient presented with a rapidly enlarging, painless right breast mass over 2 months. Clinical examination revealed a soft, poorly defined mass measuring approximately 15 × 15 cm with overlying venous engorgement. Imaging studies, including ultrasound and magnetic resonance imaging, showed a low echogenicity mass with irregular borders and non-uniform enhancement. DIAGNOSES: Histological features consistent with PASH. INTERVENTIONS: Surgical intervention confirmed a well-circumscribed mass with intact capsule. OUTCOMES: Postoperative follow-up over 1 year revealed no recurrence. LESSONS: PASH, typically diagnosed incidentally, can exhibit rapid growth and variable imaging characteristics, sometimes mimicking malignant conditions. Its occurrence in children and adolescents is uncommon, with most cases presenting as benign. The association with hormonal factors, observed in adults and those receiving hormonal treatments, suggests a potential link with endocrine changes. In conclusion, while PASH generally has a favorable prognosis, large or rapidly growing lesions in pediatric patients should be managed surgically to prevent potential functional and cosmetic issues.