Samina Khokher, Rafia Shahzad, Samia Shahbaz
A broad spectrum of primary tumors and tumor like lesions arising from the stromal tissue of the breast has been described. Because of their diverse morphological appearance and biological behavior, many of these lesions present as a diagnostic and therapeutic challenge. Large palpable tumor in the breast is a matter of great concern for the patient because it causes deformity, discomfort and mental distress for the fear of mastectomy or incurability. Presentation of Pseudoangiomatous Hyperplasia (PASH) as a giant tumor in the breast is extremely rare. Suspicion and diagnosis as a benign disease is important to avoid the surgical tragedy of mastectomy. Two cases; one in 32 years and other in 15 years old are reported. Both noticed a small lump in left breast few years ago which increased gradually initially and rapidly later to assume large size leading to obvious asymmetry and pain in the breast. First was diagnosed postoperatively on histopathology while second was suspected on ultrasound and diagnosed on Core Needle Biopsy. Both were managed by surgical excision while saving the breast. On one year follow up, the first had excellent cosmetic outcome while on 6 months follow up the adolescent affected had acceptable cosmetic outcome. Cases are reported to emphasize that PASH may present as a giant tumor in the breast which may achieve large size with time. Earlier diagnosis and simple surgical excision should be preferred to conserve the breast and get good cosmetic outcome and breast symmetry.
