From the Research
The treatment for Pseudoangiomatous Stromal Hyperplasia (PASH) should be individualized based on symptoms, patient concerns, and lesion characteristics, with surgical excision being the definitive treatment for symptomatic cases, as supported by the most recent and highest quality study 1. The management of PASH depends on various factors, including the size of the lesion, symptoms, patient preference, and risk factors.
- For asymptomatic PASH discovered incidentally, observation with regular follow-up is often sufficient as it is a benign condition.
- For symptomatic cases causing pain, discomfort, or cosmetic concerns, surgical excision is the recommended treatment, typically involving removing the affected breast tissue through a lumpectomy or wide local excision.
- In cases of diffuse PASH or recurrence, more extensive surgery such as mastectomy may be considered.
- Some patients may benefit from hormonal therapy, as PASH is hormone-responsive, though evidence for this approach is limited.
- Non-surgical management can include pain medications and supportive measures like well-fitted bras. The prognosis for PASH is excellent, with very low recurrence rates after complete excision, and importantly, it does not increase the risk of developing breast cancer, as noted in studies 2, 3. However, the most recent and highest quality study 1 suggests that close monitoring or surgical excision are required to manage large lesions (>3 cm) or progressive growth of a PASH lesion, highlighting the importance of individualized treatment approaches.