Dani Medicinske Dijaspore, Beograd 2011  Tumori mekih tkiva dojke                              Tibor Tot                  ...
M                                       i                       Epithelial                                       x        ...
M                                       i                       Epithelial                                       x        ...
Osnovne činjenice• Bilo koji tumor mekih tkiva se može  pojaviti i u dojci;• U poredjenju sa carcinomom dojke,  tumori mek...
Case courtesy ofProfessor Vincenzo Eusebi,                             KeratinBologna, Italy
Metaplastic Carcinoma of the Breastwith Neuroectodermal Stromal ComponentTibor Tot, Juan Jose Badani De La Parra,and Leif ...
CK MNF 116
Benigni tumori mekih tkiva• Nespecifični za dojku• ”Specifični” : Benign Stromal Spindle Cell  Tumors – BSSCTs       Tavas...
Nespecifični benigni tumori•   Lipoma•   Adenolipoma•   Angiomyolipoma (PECOMA)•   Angiolipoma
Capsule surrounding the circular / oval-shaped lesion                             Capsule            Lipoma               ...
Capsule surrounding the circular / oval-shaped lesion                    Male lipoma
Capsule surrounding the circular / oval-shaped lesion                                   TDLUs                             ...
Capsule surrounding the circular / oval-shaped lesion     Fibro-adeno-lipoma or “breast within the breast”
Breast within the breast (fibro-adeno-lipoma):     The fibroglandular tissue is radiopaque,        the adipose tissue is r...
• FAL  Breast within the breast
Capsule surrounding the circular / oval-shaped lesion                                 LipomaFibro-adeno-lipoma
Nespecifični benigni tumori• Angioma• BLAP: Benign LymphAngiomatous  Papules of the skin after radiotherapy
AsymptomaticSelected from screening58 yearRight breast, upper latFettily replaced breast6x4mm circular lesionFound also on...
Haemangioma of the breast
Breast haemangioma:Often asymptomaticIncidental findingsPerilobular HA:in 1,2% mastectomiesin 4,5% benign biopsiesin 11% a...
Breast haemangioma:1. Symptomatic  - Cavernous  - Capillary  - Venous2. Perilobular3. Atypical                 WHO 2002
Mariscal A. et al.Breast hemangiomamimicking carcinoma.Breast 2002 11:357-8.Gopal SV et al.Breast hemangiomasimulating ani...
Galindo LM. et al.Atypical hemangioma ofthe breast: a diagnosticpitfall in breastfine-needle aspiration.Diagn Cytopathol 2...
Honda SA, et al.Hemangioma of thebreast with atypicalhistological features.further analysis ofhistological subtypesconfirm...
Nespecifični benigni tumori• Angioma• BLAP: benign lymphangiomatous papules  of the skin after radiotherapy
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
Nespecifični benigni tumori• Nurofibroma, perineuroma, Schwannoma,  Granular cell tumor
• Case 1 diagnosed when the woman was  66 year old.• No signs of recurrences• As 80 she developed malignant lymphoma  and ...
Granular cell tumor of the breast
•   37 year old•   Palpable•   10 mm•   Follow up 14 years, alive, no signs of    recurrence
S-100
S-100   NSE   Cam5,2
Benign stromal spindle cell tumors           (BSSCTs)• With predominant myofibroblastic  differentiation• With predominant...
BSSCT        SPINDLE CELLS            VIMENTIN +                CD 34+             ER;PR;AR    CLINICALLY BENIGN ALL PUSHI...
BSSCTs with predominant     myofibroblastic differentiation•   Myofibroblastoma•   Solitary•   Any age•   Monosomy 16q&13q
Myofibroblastoma of the breast
BSSCTs with predominant       adipocytic component• Spindle cell lipoma
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
BSSCTs with prominent fibroblastic elements• Solitary fibrous tumor /  Hemangiopericytoma
Leiomyom dojke
Alpha smooth muscle actin
Maligni tumori mekih tkiva• Nespecifični za dojku• ”Specifični” : Malignant Stromal Spindle  Cell Tumors – MSSCTs       Ta...
Sarcomi dojke• Veoma retki, < 1% od svih malignih  tumora• Dr J Lamovec: 6/5382 malignih tumora u  Ljubljani za 1 godina• ...
Nespecifični maligni tumori•   Liposarcom•   Osteosarcom•   Rhabdomyosarcom•   Neurogeni maligni tumori•   (Angiosarcom)
Malignant Stromal Spindle Cell       Tumors – MSSCTs• MSSCT with predominant fibroblastic  differentiation• MSSCT with pre...
Vim    SMA      Ker   CD34  MSSCT fibroblastic       +       -       -      +/-MSSCT myofibroblastic      +       +       ...
The only difference resides in 25% ofaxillary metastases in SC and virtually          never in sarcomas.
Treatment of MSSCTs• Mastectomy (recurrences rare)• Breast conserving surgery (recurrences in  up to 2/3 of cases)• Surviv...
MSSCT with predominant         fibroblastic differentiation•   Fibrosarcoma•   Malignant fibrous histiocytoma•   Vimentin ...
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
MSSCT Fibroblastic                 Low-grade     High-gradeGrowth pattern   Herringbone   Storiform   Mitosis         2/HP...
MSSCT Fibroblastic                  Low-grade         High-gradeRecurrences          63%                44%Metastases     ...
MSSCT with predominant myofibroblastic             differentiation• Synonym: Malignant myofibroblastoma;  myofibrosarcoma....
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
Leiomyosarcoma of the breast•   Positive for vimentin, actin& desmin•   Nearly 50% of cases around nipple•   Circumscribed...
62 – year – old man with palpable lump
Erroneous FNAB diagnosis: Gynecomastia
Correct FNAB diagnosis: M y x o i d t u m o r
M y x o i d l i p o s a r c o m a of the male breast
Benign lipoma    Myxoid liposarcoma
Angiosarcoma• Definition: Malignant tumors composed of  neoplastic elements with morphological  properties of normal endot...
Angiosarcoma• Primary (de novo) in breast parenchyma.• Secondary in the skin and soft tissues of the  arm following ipsila...
Angiosarcoma - grade 1Interanastomosing channels filled with red  blood cells.Hyperchromatic nucleiDissection of interlobu...
Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
Angiosarcoma grade 3Interastomosing vascular channels.Solid areas (more than 50%)Mitoses and necrosis present      Donnel ...
Angiosarcoma grade 2Features of grade I in 75% of tumour.Rest solid areas.Endothelial tuftingMitoses numerous      Donnel ...
Case courtesy ofTUFTING   Professor Vincenzo Eusebi,          Bologna, Italy
Angiosarcoma - survival               5 - year        10 - yearGrade 1          91%              61%Grade 2          68%  ...
48 year-old woman withpalpable lump in her left breast
CD 34
CD 34
Pseudoangiomatous stromal hyperplasia
First report 1986Vuitch MI, Rosen PP, Erlandson RA. Pseudoangiomatoushyperplasia of the mammary stroma.Human Pathol 1986;1...
”prelymphatic” system linked to the main  lymph vessels in the breastHartveit F. Attenuated cells in breast stroma: the mi...
Tumor with myofibroblastic differentiationPowell CM, Cranor LM, Rosen PP. Pseudoangiomatousstromal hyperplasia (PASH). A m...
Clinical manifestations:1. Tumor forming (unilateral, firm, rubbery mass)    0,4 % of consecutive breast specimensPolger M...
Clinical manifestations:Massive (bilateral) (peau d’orange) - 1 case in Rosen’s Breast Pathology   - 1 case:   Mansouri D ...
Tumor forming PASH: 1 male caseSeidman JD et al. Rapid growth of pseudoangiomatous hyperplasiaof mammary stroma in axillar...
Male, 25 yBilateral gynecomastifollowing testosterone        intake
Radiologic appearanceA single case of round well-circumscribed tumor,3.6 cm     8.2cm in 12 monthsTaira N et al. Nodular p...
Most of the women are premenopausal,If postmenopausal HRT15 –55 (36) ys.
Puthi S et al.Tamoxifen in the management ofpseudoangiomatous stromal hyperplasia.Breast J 2001: 7:434-9
CD 34
CD 34
CD 34
SMACD 34
Normal interlobular stroma   PASH
Normal interlobular stroma   PASH
CD 34                               CD 34Normal interlobular stroma   PASH
Tumors infiltrating PASH spacesDamiani S, Eusebi V, Peterse JL. Malignant neoplasmsinfiltrating pseudoangiomatous stromal ...
- Collagenization of the interlobular stroma- Empty anastomosing spaces- Myofibroblasts resembling endothel, CD 34 + Actin...
Lui PC et al.Fine-needle aspiration cytology of pseudo –angiomatous stromal hyperplasia of thebreast.Diagn Cytopathol 2004...
Differential diagnosis:1. Myofibroblastoma - Fascicular PASH2. Low-grade angiosarcoma
PASH   Myofibroblastoma (malignant)
Differential diagnosis:1. Myofibroblastoma - Fascicular PASH2. Low-grade angiosarcoma
CD31PASH   Angiosarcoma
Hvala !
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
Tumori mekih tkiva dojke dr tibor tot
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Tumori mekih tkiva dojke dr tibor tot

  1. 1. Dani Medicinske Dijaspore, Beograd 2011 Tumori mekih tkiva dojke Tibor Tot Falun, Švedska
  2. 2. M i Epithelial x Myoepithelial e dEpithelial Mesenchymal Mixed
  3. 3. M i Epithelial x Myoepithelial e dEpithelial Mesenchymal Mixed
  4. 4. Osnovne činjenice• Bilo koji tumor mekih tkiva se može pojaviti i u dojci;• U poredjenju sa carcinomom dojke, tumori mekih tkiva u dojci su veoma retki;• Veċa je verovatnoċa da jedan tumor sa izgledom sarcoma je u stvari metaplastični karcinom ili loše differentivani phylloides tumor.
  5. 5. Case courtesy ofProfessor Vincenzo Eusebi, KeratinBologna, Italy
  6. 6. Metaplastic Carcinoma of the Breastwith Neuroectodermal Stromal ComponentTibor Tot, Juan Jose Badani De La Parra,and Leif Bergkvist.Pathology Research International 2011
  7. 7. CK MNF 116
  8. 8. Benigni tumori mekih tkiva• Nespecifični za dojku• ”Specifični” : Benign Stromal Spindle Cell Tumors – BSSCTs Tavassoli, Eusebi, Tumors of the Mammary Gland AFIP Atlas of Tumor Pathology, Series 4, 2009
  9. 9. Nespecifični benigni tumori• Lipoma• Adenolipoma• Angiomyolipoma (PECOMA)• Angiolipoma
  10. 10. Capsule surrounding the circular / oval-shaped lesion Capsule Lipoma Capsule
  11. 11. Capsule surrounding the circular / oval-shaped lesion Male lipoma
  12. 12. Capsule surrounding the circular / oval-shaped lesion TDLUs Adipose tissue Fibrosis CapsuleC Fibro-adeno-lipoma. Breast within the breast
  13. 13. Capsule surrounding the circular / oval-shaped lesion Fibro-adeno-lipoma or “breast within the breast”
  14. 14. Breast within the breast (fibro-adeno-lipoma): The fibroglandular tissue is radiopaque, the adipose tissue is radiolucent.
  15. 15. • FAL Breast within the breast
  16. 16. Capsule surrounding the circular / oval-shaped lesion LipomaFibro-adeno-lipoma
  17. 17. Nespecifični benigni tumori• Angioma• BLAP: Benign LymphAngiomatous Papules of the skin after radiotherapy
  18. 18. AsymptomaticSelected from screening58 yearRight breast, upper latFettily replaced breast6x4mm circular lesionFound also on ultrasoundRadiologic dg.:Susp mucinous cancer
  19. 19. Haemangioma of the breast
  20. 20. Breast haemangioma:Often asymptomaticIncidental findingsPerilobular HA:in 1,2% mastectomiesin 4,5% benign biopsiesin 11% autopsiesRosen PP, Rindolfi RL.Am J Clin Pathol 68:21-23, 1977
  21. 21. Breast haemangioma:1. Symptomatic - Cavernous - Capillary - Venous2. Perilobular3. Atypical WHO 2002
  22. 22. Mariscal A. et al.Breast hemangiomamimicking carcinoma.Breast 2002 11:357-8.Gopal SV et al.Breast hemangiomasimulating aninflammatory carcinomaBreast J 2005 11:498-9
  23. 23. Galindo LM. et al.Atypical hemangioma ofthe breast: a diagnosticpitfall in breastfine-needle aspiration.Diagn Cytopathol 2001 24:215-8.
  24. 24. Honda SA, et al.Hemangioma of thebreast with atypicalhistological features.further analysis ofhistological subtypesconfirming their benigncharacter.Am J Surg Pathol 1992 16:553-60.
  25. 25. Nespecifični benigni tumori• Angioma• BLAP: benign lymphangiomatous papules of the skin after radiotherapy
  26. 26. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  27. 27. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  28. 28. Nespecifični benigni tumori• Nurofibroma, perineuroma, Schwannoma, Granular cell tumor
  29. 29. • Case 1 diagnosed when the woman was 66 year old.• No signs of recurrences• As 80 she developed malignant lymphoma and died of that disease.
  30. 30. Granular cell tumor of the breast
  31. 31. • 37 year old• Palpable• 10 mm• Follow up 14 years, alive, no signs of recurrence
  32. 32. S-100
  33. 33. S-100 NSE Cam5,2
  34. 34. Benign stromal spindle cell tumors (BSSCTs)• With predominant myofibroblastic differentiation• With predominant adipocytic component• With prominent fibroblastic elements• (Leiomyoma / variants)
  35. 35. BSSCT SPINDLE CELLS VIMENTIN + CD 34+ ER;PR;AR CLINICALLY BENIGN ALL PUSHING BORDERS
  36. 36. BSSCTs with predominant myofibroblastic differentiation• Myofibroblastoma• Solitary• Any age• Monosomy 16q&13q
  37. 37. Myofibroblastoma of the breast
  38. 38. BSSCTs with predominant adipocytic component• Spindle cell lipoma
  39. 39. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  40. 40. BSSCTs with prominent fibroblastic elements• Solitary fibrous tumor / Hemangiopericytoma
  41. 41. Leiomyom dojke
  42. 42. Alpha smooth muscle actin
  43. 43. Maligni tumori mekih tkiva• Nespecifični za dojku• ”Specifični” : Malignant Stromal Spindle Cell Tumors – MSSCTs Tavassoli, Eusebi, Tumors of the Mammary Gland AFIP Atlas of Tumor pathology, Series 4, 2009
  44. 44. Sarcomi dojke• Veoma retki, < 1% od svih malignih tumora• Dr J Lamovec: 6/5382 malignih tumora u Ljubljani za 1 godina• Dalarna 2005-2011 oktobra, 1/1493 malignih slucajeva
  45. 45. Nespecifični maligni tumori• Liposarcom• Osteosarcom• Rhabdomyosarcom• Neurogeni maligni tumori• (Angiosarcom)
  46. 46. Malignant Stromal Spindle Cell Tumors – MSSCTs• MSSCT with predominant fibroblastic differentiation• MSSCT with predominant myofibroblastic differentiation• (Leiomyosarcoma)
  47. 47. Vim SMA Ker CD34 MSSCT fibroblastic + - - +/-MSSCT myofibroblastic + + - + Monophasic + - + -sarcomatoid carcinomaMyoepithelial carcinoma + + -/+ - Based on Tavassoli, Eusebi AFIP 4, page 291
  48. 48. The only difference resides in 25% ofaxillary metastases in SC and virtually never in sarcomas.
  49. 49. Treatment of MSSCTs• Mastectomy (recurrences rare)• Breast conserving surgery (recurrences in up to 2/3 of cases)• Survival ?• Metastases to the lungs, liver, GI tract, adrenals, brain, bones, pleura and retroperitoneum.
  50. 50. MSSCT with predominant fibroblastic differentiation• Fibrosarcoma• Malignant fibrous histiocytoma• Vimentin only• Diagnosis by exclusion
  51. 51. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  52. 52. MSSCT Fibroblastic Low-grade High-gradeGrowth pattern Herringbone Storiform Mitosis 2/HPV 12/HPV Necrosis -/+ ++Nuclear atypia little variable
  53. 53. MSSCT Fibroblastic Low-grade High-gradeRecurrences 63% 44%Metastases none 25% Deaths none 31% Jones et al. Am.J.Surg.Pathol. 16: 667-674,1992
  54. 54. MSSCT with predominant myofibroblastic differentiation• Synonym: Malignant myofibroblastoma; myofibrosarcoma.• Vimentin +, SMA +, Keratin -
  55. 55. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  56. 56. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  57. 57. Leiomyosarcoma of the breast• Positive for vimentin, actin& desmin• Nearly 50% of cases around nipple• Circumscribed margins• Mitotic count no same impact as uterus• Moderately aggressive neoplasms• Complete excision the ONLY treatment
  58. 58. 62 – year – old man with palpable lump
  59. 59. Erroneous FNAB diagnosis: Gynecomastia
  60. 60. Correct FNAB diagnosis: M y x o i d t u m o r
  61. 61. M y x o i d l i p o s a r c o m a of the male breast
  62. 62. Benign lipoma Myxoid liposarcoma
  63. 63. Angiosarcoma• Definition: Malignant tumors composed of neoplastic elements with morphological properties of normal endothelial cells.• Synonym: hemangiosarcoma; hemangioblastoma; lymphangiosarcoma
  64. 64. Angiosarcoma• Primary (de novo) in breast parenchyma.• Secondary in the skin and soft tissues of the arm following ipsilateral radical mastectomy and subsequent lymphedema (Stewart - Treves syndrome).• Secondary in the skin and chest wall following radical mastectomy and local radiotherapy.• Secondary in the skin or breast parenchyma or both following conservative treatment and radiotherapy.
  65. 65. Angiosarcoma - grade 1Interanastomosing channels filled with red blood cells.Hyperchromatic nucleiDissection of interlobular and intralobular stromaGlands entrappedMitoses and necrosis absent Donnel et al. Am J Surg Pathol 5:629-642,1981
  66. 66. Case courtesy ofProfessor Vincenzo Eusebi,Bologna, Italy
  67. 67. Angiosarcoma grade 3Interastomosing vascular channels.Solid areas (more than 50%)Mitoses and necrosis present Donnel et al. Am J Surg Pathol 5:629-642,1981
  68. 68. Angiosarcoma grade 2Features of grade I in 75% of tumour.Rest solid areas.Endothelial tuftingMitoses numerous Donnel et al. Am J Surg Pathol 5:629-642,1981
  69. 69. Case courtesy ofTUFTING Professor Vincenzo Eusebi, Bologna, Italy
  70. 70. Angiosarcoma - survival 5 - year 10 - yearGrade 1 91% 61%Grade 2 68% 68%Grade 3 31% 14%Donnel et al. Am J Surg Pathol 5:629-642,1981
  71. 71. 48 year-old woman withpalpable lump in her left breast
  72. 72. CD 34
  73. 73. CD 34
  74. 74. Pseudoangiomatous stromal hyperplasia
  75. 75. First report 1986Vuitch MI, Rosen PP, Erlandson RA. Pseudoangiomatoushyperplasia of the mammary stroma.Human Pathol 1986;17:185-91
  76. 76. ”prelymphatic” system linked to the main lymph vessels in the breastHartveit F. Attenuated cells in breast stroma: the missing lymphatic system of the breast. Histopathology 1990;16:533-43
  77. 77. Tumor with myofibroblastic differentiationPowell CM, Cranor LM, Rosen PP. Pseudoangiomatousstromal hyperplasia (PASH). A mammary stromal tumorwith myofibroblastic differentiation.Am J Surg Pathol 1995; 19:270-7.
  78. 78. Clinical manifestations:1. Tumor forming (unilateral, firm, rubbery mass) 0,4 % of consecutive breast specimensPolger MR et al. Pseudoangoiomatous stromal hypeplasia: mammographicand sonographic appearance. AJR 1996 166:349-52.2. Incidental /microscopical 23 % of consecutive breast specimensIbrahim RE et al. Pseudoangoiomatous hypeplasia of the mammary stroma;some observations regarding its clinicoapathologic spectrum.Cancer 1989 63 1154 -603. Massive bilateral (peau d’orange) (1 case in Rosen’s Breast Pathology)
  79. 79. Clinical manifestations:Massive (bilateral) (peau d’orange) - 1 case in Rosen’s Breast Pathology - 1 case: Mansouri D et al. Pseudoangiomatous stromal hyperplaia of mammary stroma: a case with gigantomastia. Ann Pathol 2004; 24:179-82 +1
  80. 80. Tumor forming PASH: 1 male caseSeidman JD et al. Rapid growth of pseudoangiomatous hyperplasiaof mammary stroma in axillary gynecomastia in an immunosuppressed man.Arch Pathol Lab Med 1993:117:736-8PASH:frequent incidental finding in gynecomastia(23 – 47 %)Milanesi MF et al. Pseudoangiomatous hyperplasia of mammary stromaassociated with gynecomastia J Clin Pathol 1998:51 204-6Badve S, Soane JP. Pseudoangiomatous stromal hyperplasia of male breast.Histopathology 1995 26:463-6
  81. 81. Male, 25 yBilateral gynecomastifollowing testosterone intake
  82. 82. Radiologic appearanceA single case of round well-circumscribed tumor,3.6 cm 8.2cm in 12 monthsTaira N et al. Nodular pseudoangiomatous stromal hyperplasia of mammarytroma in a case showing rapid tumor growth. Breast Cancer 2005; 12:331-6
  83. 83. Most of the women are premenopausal,If postmenopausal HRT15 –55 (36) ys.
  84. 84. Puthi S et al.Tamoxifen in the management ofpseudoangiomatous stromal hyperplasia.Breast J 2001: 7:434-9
  85. 85. CD 34
  86. 86. CD 34
  87. 87. CD 34
  88. 88. SMACD 34
  89. 89. Normal interlobular stroma PASH
  90. 90. Normal interlobular stroma PASH
  91. 91. CD 34 CD 34Normal interlobular stroma PASH
  92. 92. Tumors infiltrating PASH spacesDamiani S, Eusebi V, Peterse JL. Malignant neoplasmsinfiltrating pseudoangiomatous stromal hyperplasia ofthe breast: an unrecognized pathway of tumour spread.Histopathology 2002 41; 208-15.
  93. 93. - Collagenization of the interlobular stroma- Empty anastomosing spaces- Myofibroblasts resembling endothel, CD 34 + Actin +/-, Vim +, CK-, FVIII- progesterone +/-
  94. 94. Lui PC et al.Fine-needle aspiration cytology of pseudo –angiomatous stromal hyperplasia of thebreast.Diagn Cytopathol 2004 30:353-5.
  95. 95. Differential diagnosis:1. Myofibroblastoma - Fascicular PASH2. Low-grade angiosarcoma
  96. 96. PASH Myofibroblastoma (malignant)
  97. 97. Differential diagnosis:1. Myofibroblastoma - Fascicular PASH2. Low-grade angiosarcoma
  98. 98. CD31PASH Angiosarcoma
  99. 99. Hvala !

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