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Saoud S, Arreyouchi D, Ankiz A, Haloui A, Karich N, Bennani A, Oufkir AA. Pseudoangiomatous stromal hyperplasia: a rare cause of gynecomastia in men. Case Reports Plast Surg Hand Surg 2024; 11:2303993. [PMID: 38250333 PMCID: PMC10798276 DOI: 10.1080/23320885.2024.2303993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
A 17-year-old male with chest malformation and left breast enlargement underwent surgery for gynecomastia. Histological examination revealed mammary fibrous stroma with ductal hyperplasia and features of pseudoangiomatous stromal hyperplasia. Postoperative follow-up showed no complications, but 8 months later, the patient experienced a mild recurrence with enlargement of the nipple-areolar complex. Although recommended for secondary glandular resection, the patient declined further surgery.
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Affiliation(s)
- Sarah Saoud
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
| | - Doha Arreyouchi
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
| | - Anas Ankiz
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
| | - Anass Haloui
- Department of Pathology, Central Laboratory, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Nassira Karich
- Department of Pathology, Central Laboratory, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Amal Bennani
- Department of Pathology, Central Laboratory, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Ayat Allah Oufkir
- Department of Burns and reconstructive Surgery, Mohamed 6 hospital, Oujda Research Laboratory in Medical Sciences, Faculty of Medicine and Pharmacy of Oujda, Mohamed First University, Oujda, Morocco
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Bahia PVB, Nascimento MM, da Rocha GO, de Andrade JB, Machado ME. Quantification of polycyclic aromatic sulfur heterocycles in fine airborne urban particles (PM 2.5) after multivariate optimization of a green procedure. Sci Total Environ 2023; 898:165465. [PMID: 37451461 DOI: 10.1016/j.scitotenv.2023.165465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
Polycyclic aromatic sulfur heterocycles (PASHs), such as benzothiophenes (BT), dibenzothiophenes (DBT) and benzonapthothiophenes (BNT), can be emitted from vehicular traffic and deposited in fine particles matter (PM2.5). The presence of these compounds in PM2.5 is an environmental concern due to air pollution and its toxic properties. In this study, a green microscale solid-liquid extraction method was developed to determine twenty-three PASHs in PM2.5. A simplex-centroid mixture design was applied to optimize the extraction solvent. A full factorial design was used for preliminary evaluation of the factors that influence the extraction process (extraction time, sample size, and solvent volume) and then a Doehlert design for the significant parameters. The optimal extraction conditions based on the experimental design were: sample size, 4.15 cm2; 450 μL of toluene:dichloromethane (80:20,v/v); and extraction duration, 24 min. High sensitivity (LOD < 0.66pg m-3 and LOQ < 2.21 pg m-3) and acceptable recovery (82.8-120 %), and precision (RSD 3.6-14.0 %) were obtained. The greenness of the method was demonstrated using the Analytical GREEnness (AGREE) tool. The method was applied for analyzing PASHs in PM2.5 samples collected in three time intervals per day from years with different sulfur contents in the diesel: S-500 (≤500 ppm sulfur) and S-50 (≤50 ppm sulfur). Fourteen PASHs were quantified with the highest concentrations observed for 2,8-DMDBT and 4,6-DMDBT, which are recalcitrant compounds. The ANOVA test indicated significant differences between sampling periods during the day. The reduction of diesel S-500 to S-50 corresponded to a 28 % decrease in the total sum of PASHs (∑PASHs) evaluated. Spearman's rank correlations allowed for verifying that BTs and DBTs were highly correlated, suggesting that they were derived from similar sources. A weak correlation of 2,1-BNT and 2,3-BNT with BTs and DBTs indicates that these compounds are a chemical proxy for the emission of diesel engines during the combustion process.
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Affiliation(s)
- Pedro Victor Bomfim Bahia
- Centro Interdisciplinar de Energia e Ambiente-CIEnAm, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil; Universidade Federal da Bahia, Instituto de Química, Programa de Pós-Graduação em Química, 40170-115, Salvador, BA, Brazil
| | - Madson Moreira Nascimento
- Centro Interdisciplinar de Energia e Ambiente-CIEnAm, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil; Instituto Nacional de Ciência e Tecnologia em Energia e Ambiente-INCT E&A, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil
| | - Gisele Olimpio da Rocha
- Centro Interdisciplinar de Energia e Ambiente-CIEnAm, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil; Universidade Federal da Bahia, Instituto de Química, Programa de Pós-Graduação em Química, 40170-115, Salvador, BA, Brazil; Instituto Nacional de Ciência e Tecnologia em Energia e Ambiente-INCT E&A, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil
| | - Jailson Bittencourt de Andrade
- Centro Interdisciplinar de Energia e Ambiente-CIEnAm, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil; Instituto Nacional de Ciência e Tecnologia em Energia e Ambiente-INCT E&A, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil; Centro Universitário SENAI-CIMATEC, Av. Orlando Gomes, 1845 Piatã, 41650-010, Salvador, BA, Brazil
| | - Maria Elisabete Machado
- Centro Interdisciplinar de Energia e Ambiente-CIEnAm, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil; Universidade Federal da Bahia, Instituto de Química, Programa de Pós-Graduação em Química, 40170-115, Salvador, BA, Brazil; Instituto Nacional de Ciência e Tecnologia em Energia e Ambiente-INCT E&A, Universidade Federal da Bahia, 40170-115, Salvador, BA, Brazil.
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Xu QX, Bafort J, Decloedt J. A Rare Case of Pseudoangiomatous Stromal Hyperplasia in a Male Patient. J Belg Soc Radiol 2023; 107:85. [PMID: 37928053 PMCID: PMC10624136 DOI: 10.5334/jbsr.3356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Teaching Point: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast condition that can mimic the appearance of breast cancer on imaging studies.
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Affiliation(s)
- Qun Xia Xu
- Department of Radiology, AZ Sint Blasius, Dendermonde, Belgium
| | - Johan Bafort
- Department of Radiology, AZ Sint Blasius, Dendermonde, Belgium
| | - Jan Decloedt
- Breast Unit, AZ Sint Blasius, Dendermonde, Belgium
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Jorns JM, Farooq A, Puzyrenko A, Jarzembowski J, Thike AA, Nasir NDM, Ng CCY, Liu W, Lee JY, Lim AH, Guan P, Teh BT, Tan PH. Giant juvenile fibroadenomas with and without prominent pseudoangiomatous stromal hyperplasia ( PASH)-like change: clinicopathological and molecular characteristics. Histopathology 2023; 83:357-365. [PMID: 37140543 DOI: 10.1111/his.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
AIMS Juvenile fibroadenomas (JFA) are biphasic fibroepithelial lesions (FEL) usually occurring in adolescent female patients. Giant (G) JFA, like other FEL, may exhibit prominent pseudoangiomatous stromal hyperplasia (PASH)-like change. We sought to determine clinicopathological and molecular characteristics of GJFA with and without PASH. METHODS AND RESULTS Archives were searched for cases of GJFA (1985-2020). All were stained for androgen receptor (AR), beta-catenin, CD34 and progesterone receptor (PR). Cases were sequenced using a custom 16-gene panel - MED12 (exons 1 and 2), TERT promoter (-124C>T and -146Ctable>T), SETD2, KMT2D, RARA (exons 5-9), FLNA, NF1, PIK3CA (exons 10, 11 and 21), EGFR, RB1, BCOR, TP53, PTEN, ERBB4, IGF1R and MAP3K1. Twenty-seven GJFA from 21 female patients aged 10.1-25.2 years were identified. Size ranged from 5.2 to 21 cm. Two patients had multiple, bilateral and later recurrent GJFA. Thirteen (48%) cases showed prominent PASH-like stroma. All were positive for stromal CD34, negative for AR and beta-catenin and one case showed focal PR expression. Sequencing showed MAP3K1 and SETD2 mutations in 17 samples, with KMT2D, TP53 and BCOR aberrations in 10 (45%), 10 (45%) and seven (32%) cases, respectively. Tumours with a PASH-like pattern had higher prevalence of SETD2 (P = 0.004) and TP53 (P = 0.029) mutations, while those without PASH had more RB1 mutations (P = 0.043). MED12 mutation was identified in one case. TERT promoter mutation was observed in four (18%), including two recurrences. CONCLUSIONS Gene mutations along more advanced phases of the proposed FEL pathogenetic pathway in GJFA are unusual, and suggest a mechanism for more aggressive growth in these tumours.
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Affiliation(s)
- Julie M Jorns
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrii Puzyrenko
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jason Jarzembowski
- Department of Pathology, Children's Hospital of Wisconsin, Madison, WI, USA
| | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | | | | | - Wei Liu
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Jing Yi Lee
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Abner Herbert Lim
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Quantitative Biology and Medicine Programme, Duke-NUS Medical School, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
| | - Puay Hoon Tan
- Luma Medical Centre, Singapore
- KK Women's and Children's Hospital, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pathology, University of Western Sydney, Sydney, NSW, Australia
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5
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Miyamoto A, Werner K, Schmidt FTC. A reciprocal perspective on the differential associations between personality traits and multiple indicators of academic achievement. J Pers 2023. [PMID: 37564023 DOI: 10.1111/jopy.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This study aims to explore the reciprocal associations between personality traits (conscientiousness and openness to experience) and academic achievement in adolescents, using the Personality Achievement Saturation Hypothesis (PASH). BACKGROUND Personality traits, especially conscientiousness, and openness, have been identified as strong predictors of academic achievement. The PASH provides a framework for understanding these relationships but has mainly been studied from a unidirectional perspective. This study extends the PASH to examine reciprocal associations and how they vary with different achievement indicators. METHODS Using large-scale panel data (N = 6482) of secondary school students in Germany, we applied cross-lagged panel models and latent change score models to examine the differential reciprocal associations between personality traits (conscientiousness/openness) and academic achievement (school grades/achievement test scores) in language and math over two years from grades 7 to 9. RESULTS In line with the PASH, initial levels of conscientiousness were more strongly associated with school grades than with achievement test scores over two years. Simultaneously, prior school grades were more strongly associated with conscientiousness over two years. However, initial levels of openness did not show differential associations with either school grades or achievement test scores over two years. Similarly, prior school grades and achievement test scores were also not differentially associated with openness over two years. CONCLUSIONS Our findings introduce an innovative lens through which we observe how the PASH can be leveraged to explain the differential reciprocal associations between conscientiousness and academic achievement. Further research is needed to examine if PASH could be similarly extended to disentangle the associations between openness and academic achievement.
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Affiliation(s)
- Ai Miyamoto
- University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Werner
- Leibniz Institute for Economic Research at the University of Munich, Munich, Germany
| | - Fabian T C Schmidt
- University of Hamburg, Hamburg, Germany
- University of Hildesheim, Hildesheim, Germany
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Kikuchi DS, Mustin DE, Ghanouni A, Walsh MD. A review of pediatric macromastia etiology and indications for reduction mammaplasty. J Plast Reconstr Aesthet Surg 2023; 77:209-217. [PMID: 36587475 DOI: 10.1016/j.bjps.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Macromastia in adolescents is both physically and psychologically debilitating during a period in life when individuals are particularly vulnerable to peer pressure and social norms. Early recognition and intervention by both pediatricians and surgeons are critical to avoid unnecessary suffering. While reduction mammaplasty is the gold standard for the management of symptomatic macromastia in adults, the management of macromastia in pediatric patients remains controversial. In particular, there is great discussion regarding the timing of reconstructive breast surgery in pediatric patients. METHODS A comprehensive review of the literature was performed to identify all articles related to macromastia in patients ≤16 years of age, the age at which full development is typically achieved in the United States. The etiologies of pediatric macromastia, approaches to management, and outcomes are summarized herein. FINDINGS Pathological breast hypertrophy in pediatric patients is a rare finding and may occur secondary to juvenile hypertrophy of the breast (JHB) and pseudoangiomatous stromal hyperplasia (PASH). While medical management of these pathologies has been attempted with varying success, reduction mammaplasty is safe and effective in pediatric patients. There are, however, a number of pediatric-specific considerations that must be taken into account prior to surgery. We provide an algorithm for approaching pediatric macromastia.
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Affiliation(s)
- Daniel S Kikuchi
- Osler Medical Residency, Johns Hopkins Hospital, Baltimore, MD, United States
| | | | - Arian Ghanouni
- General Surgery Residency, Emory University Hospital, Atlanta, GA, United States
| | - Mark D Walsh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University, United States
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Alikhassi A, Skarpathiotakis M, Lu FL, Curpen B. Pseudoangiomatous stromal hyperplasia of the breast, imaging and clinical perspective: A review. Breast Dis 2023; 42:147-153. [PMID: 37154175 DOI: 10.3233/bd-220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast pathology, which most commonly presents incidentally along with other breast pathologies. The etiology and pathogenesis of PASH are still unknown; however, there is some evidence suggesting PASH is hormone dependent. The clinical history, presentation, and imaging appearance of PASH are variable. Clinically, PASH has a wide spectrum of presentations, from being silent to gigantomastia. On imaging, PASH demonstrates various benign to suspicious features. Here we summarize PASH's clinical presentation, histopathology, imaging features, and management.
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Affiliation(s)
- Afsaneh Alikhassi
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mia Skarpathiotakis
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Fang-L Lu
- Precision Diagnostics and Therapeutics Program (Laboratory Medicine), Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Belinda Curpen
- Division of Breast Imaging, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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8
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Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. PASH is postulated to be hormonally induced and predominantly occurs in premenopausal women and postmenopausal women on menopausal hormone therapy. Clinical presentation varies from screen-detected lesions to palpable masses. Imaging findings of PASH are nonspecific. The most common mammographic findings are an oval or round circumscribed non-calcified mass or developing asymmetry. On US, PASH is often seen as an oval hypoechoic mass that may be circumscribed and can have an echogenic rim, or, when manifest as mammographic asymmetry, US may show a corresponding non-mass focal area of echogenic tissue. Limited studies have investigated the MRI appearance, with PASH most often manifesting as non-mass enhancement, or, less often, as an oval or irregular mass with persistent kinetics. Histopathologically, PASH can be mistaken for a fibroadenoma or phyllodes tumor and has features overlapping low-grade angiosarcoma. Assessment of radiologic-pathologic concordance is particularly important as PASH is often an incidental finding, adjacent to the targeted lesion at histopathology. Surgical excision or repeat core-needle biopsy is necessary for discordant suspicious cases. After a benign, concordant diagnosis of PASH, the patient may resume routine screening.
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Affiliation(s)
- Megan E Speer
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
| | - Esther C Yoon
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Wendie A Berg
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Department of Radiology, Pittsburgh, PA, USA
| | - Lauren Q Chang Sen
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
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Brandão LAC, de Moura RR, Marzano AV, Moltrasio C, Tricarico PM, Crovella S. Variant Enrichment Analysis to Explore Pathways Functionality in Complex Autoinflammatory Skin Disorders through Whole Exome Sequencing Analysis. Int J Mol Sci 2022; 23:2278. [PMID: 35216413 PMCID: PMC8877088 DOI: 10.3390/ijms23042278] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/04/2022] Open
Abstract
The challenge of unravelling the molecular basis of multifactorial disorders nowadays cannot rely just on association studies searching for potential causative variants shared by groups of patients and not present in healthy individuals; indeed, association studies have as a main limitation the lack of information on the interactions between the disease-causing variants. Thus, new genomic analysis tools focusing on disrupted pathways rather than associated gene variants are required to better understand the complexity of a disease. Therefore, we developed the Variant Enrichment Analysis (VEA) workflow, a tool applicable for whole exome sequencing data, able to find differences between the numbers of genetic variants in a given pathway in comparison with a reference dataset. In this study, we applied VEA to discover novel pathways altered in patients with complex autoinflammatory skin disorders, namely PASH (n = 9), 3 of whom are overlapping with SAPHO) and PAPASH (n = 3). With this approach we have been able to identify pathways related to neutrophil and endothelial cells homeostasis/activations, as disrupted in our patients. We hypothesized that unregulated neutrophil transendothelial migration could elicit increased neutrophil infiltration and tissue damage. Based on our findings, VEA, in our experimental dataset, allowed us to predict novel pathways impaired in subjects with autoinflammatory skin disorders.
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Affiliation(s)
- Lucas André Cavalcanti Brandão
- Department of Advanced Diagnostics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.A.C.B.); (P.M.T.)
| | - Ronald Rodrigues de Moura
- Department of Advanced Diagnostics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.A.C.B.); (P.M.T.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.V.M.); (C.M.)
- Department of Physiopathology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.V.M.); (C.M.)
- Department of Medical Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (L.A.C.B.); (P.M.T.)
| | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha 2713, Qatar;
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Nikolakis G, Kreibich K, Vaiopoulos A, Kaleta K, Talas J, Becker M, Zouboulis CC. Case Report: PsAPSASH syndrome: an alternative phenotype of syndromic hidradenitis suppurativa treated with the IL-17A inhibitor secukinumab. F1000Res 2021; 10:381. [PMID: 34540202 PMCID: PMC8424462 DOI: 10.12688/f1000research.52100.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
Syndromic hidradenitis suppurativa (HS) is a form of symptom constellations, which differs from the familial and genetic form and comprises predominantly osteoarticular manifestations. Many forms include pyoderma gangrenosum and acne (PASH), pyogenic arthritis (PAPASH), spondyloarthritis (PASS) and psoriatic arthritis (PsAPASH) and are categorized in the autoinflammatory syndromes. Anti-TNF-α and anti-IL-1a blockade are between the therapeutic approaches that improve skin symptoms and prevent permanent osteoarticular damage. This case report refers to the successful treatment of a mixed phenotype of the aforementioned symptoms using the IL-17A inhibitor secukinumab after initial treatment with adalimumab. The therapy improved both cutaneous and reported osteoarticular symptoms. Different approaches for these recalcitrant HS syndromes are essential in order to achieve long-term remission for those patients.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, 06847, Germany
| | - Katja Kreibich
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany
| | - Aristeidis Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, 06847, Germany
| | - Katarzyna Kaleta
- Department of Dermatology, Jagiellonian University Medical College, Krakow, 31-008, Poland
| | - Joud Talas
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany
| | - Markus Becker
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, 06847, Germany
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11
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Affiliation(s)
- Bing-Jie Xiang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang City, Liaoning Province, China
| | - Yu-Hong Huang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang City, Liaoning Province, China
| | - Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang City, Liaoning Province, China
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12
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Nia ES, Adrada BE, Whitman GJ, Candelaria RP, Krishnamurthy S, Bassett RL, M Arribas E. MRI features of pseudoangiomatous stromal hyperplasia with histopathological correlation. Breast J 2021; 27:242-247. [PMID: 33393706 DOI: 10.1111/tbj.14154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 02/02/2023]
Abstract
Pseudoangiomatous stromal hyperplasia (PASH), a rare, noncancerous lesion, is often an incidental finding on magnetic resonance imaging (MRI)-guided biopsy analysis of other breast lesions. We sought to describe the characteristics of PASH on MRI and identify the extent to which these characteristics are correlated with the amount of PASH in the pathology specimens. We identified 69 patients who underwent MRI-guided biopsies yielding a final pathological diagnosis of PASH between 2008 and 2015. We analyzed pre-biopsy MRI scans to document the appearance of the lesions of interest. All biopsy samples were classified as having ≤50% PASH or ≥51% PASH present on the pathological specimen. On MRI, 9 lesions (13%) appeared as foci, 19 (28%) appeared as masses with either washout or persistent kinetics, and 41 (59%) appeared as regions of nonmass enhancement. Of this latter group, 33 lesions (80%) showed persistent kinetic features. Masses, foci, and regions of nonmass enhancement did not significantly correlate with the percentage of PASH present in the biopsy specimens (P ≥ .05). Our findings suggest that PASH has a wide-ranging appearance on MRI but most commonly appears as a region of nonmass enhancement with persistent kinetic features. Our finding that most specimens had ≤50% PASH supports the notion that PASH is usually an incidental finding. We did not identify a definitive imaging characteristic that reliably identifies PASH.
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Affiliation(s)
- Emily S Nia
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary J Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalind P Candelaria
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elsa M Arribas
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Hattingh G, Ibrahim M, Robinson T, Shah A. The effect of hormones on an uncommon breast disorder pseudoangiomatous stromal hyperplasia: a case report and literature review. J Surg Case Rep 2020; 2020:rjaa514. [PMID: 33391644 PMCID: PMC7765708 DOI: 10.1093/jscr/rjaa514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/08/2020] [Accepted: 11/27/2020] [Indexed: 11/14/2022] Open
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of the breast, with few cases reported to date. While the etiology of the disease is uncertain, a prevailing theory is that PASH is hormonally responsive, especially in the presence of progesterone. Literature review shows a correlation between PASH development and oral contraceptive pill (OCP) use. We report a case of a 28-year-old autistic female who underwent excision of palpable bilateral breast masses where the histology of the left breast mass identified as PASH. Our patient had a history of multiple medications including OCPs and cytochrome p450 inhibitors that could lead to an increase in progesterone levels. Thus, supporting a theory that medications, in addition to OCPs, may lead to an increased occurrence of PASH in pre-menopausal women.
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Affiliation(s)
- Genevieve Hattingh
- Correspondence address. Department of Surgery, 1650 Grand Concourse, Bronx, NY 10457. Tel: (360) 820-1959; Fax: (718) 960-370; E-mail:
| | - Mariam Ibrahim
- Department of Surgery, Bronxcare Health System, Bronx, NY, USA
| | - Thomas Robinson
- American University of the Caribbean School of Medicine, St. Maarten, Netherland Antilles
| | - Ajay Shah
- Department of Surgery, Bronxcare Health System, Bronx, NY, USA
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14
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Santanelli di Pompeo F, Sorotos M, Passarelli F, Berrino V, Firmani G, Winters H, Paolini G. Pseudoangiomatous stromal hyperplasia: an unsuspected cause of anisomasty. Case Reports Plast Surg Hand Surg 2020; 7:112-115. [PMID: 33134428 PMCID: PMC7580785 DOI: 10.1080/23320885.2020.1824614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Breast asymmetry can be congenital or developmental, however a tumorous growth may be the cause of this condition after puberty. A 19-year-old female presented with a slowly developing breast asymmetry pre-operatively diagnosed as Pseudoangiomatous Stromal Hyperplasia (PASH). The patient underwent tumour excision with breast gland remodelling. Postoperative course was uneventful.
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', PhD School of Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | | | - Valeria Berrino
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
| | - Guido Firmani
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
| | - Harm Winters
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Guido Paolini
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
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15
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Noda Y, Nishimae A, Sawai Y, Inaji H, Yamasaki M. Atypical pseudoangiomatous stromal hyperplasia showing rapid growth of the breast: Report of a case. Pathol Int 2019; 69:300-305. [PMID: 30957322 DOI: 10.1111/pin.12786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign lesion manifesting as myofibroblastic proliferation and anastomosing slit-like spaces. Atypical PASH is an extremely rare lesion characterized by cytological alteration of myofibroblast, presenting as myofibroblastic sarcoma arising from PASH. To our knowledge, only one other case has been reported since the first report of Rosen. We present a case of atypical PASH. A 39-year-old female presented with a round, elastic hard, painless mass in the left breast. Mammography and ultrasonography revealed no definitive sign of malignancy. Core needle biopsy report was suggestive of atypical PASH. Five months later, the mass had grown rapidly with pain. Considering the clinicopathological features, excision was performed. Pathological examination revealed the spindle cells proliferation in collagenous stroma. The spindle cell involved the adipose tissue and lobules and lined peudoangiomatous spaces. These cells exhibited marked cytological atypia and mitotic activity. Immunohistochemically, these spindle cells were positive for SMA, CD10, and bcl-2, and negative for podoplanin, p63, CD31, ERG and cytokeratins. The final diagnosis was atypical PASH. She is tumor-free on 12 months follow-up. The nature of atypical PASH remains unknown. Further studies are required for a clear definition, a new histological entity and diagnostic criteria.
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Affiliation(s)
- Yuri Noda
- Department of Diagnostic Pathology, Kaizuka City Hospital, Osaka, Japan
| | - Ayaka Nishimae
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Yuka Sawai
- Department of Radiology, Kaizuka City Hospital, Osaka, Japan
| | - Hideo Inaji
- Department of Breast Surgery, Kaizuka City Hospital, Osaka, Japan
| | - Masaru Yamasaki
- Department of Diagnostic Pathology, Kaizuka City Hospital, Osaka, Japan
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16
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Abstract
Developmental abnormalities and malformations of the breast are rare and encompass a variety of genetic, syndromic, acquired and sporadic conditions. Abnormalities in development may include irregularities in the nipple areolar complex and/or the underlying glandular tissue, resulting in under or overdevelopment of breasts. Age of presentation and clinical severity is dependent on the underlying biologic cause. Abnormalities may involve the entirety of unilateral or bilateral breasts, particularly in association with syndromic conditions or endocrine abnormalities. Disordered development may also be focal, resulting in tumor-like lesions such as hamartomas, pseudoangiomatous stromal hyperplasia and gynecomastia. In this review, we discuss the disorders of breast development including etiologies, clinical presentations and corresponding histopathologic features.
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Affiliation(s)
- Emily Reisenbichler
- Department of Pathology, Yale School of Medicine, Yale New Haven Hospital, 310 Cedar St, New Haven, CT 06510, United States
| | - Krisztina Z Hanley
- Department of Pathology, Emory University Hospital, Atlanta, GA 30322, United States.
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17
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Morone I, de Andrade GP, Cardoso PS, de Oliveira AC, Clímaco F, Medeiros J, Franco D. Bilateral pseudoangiomatous stromal hyperplasia in childhood gigantomastia: A challenge in reconstruction and management. JPRAS Open 2018; 19:106-110. [PMID: 32158862 PMCID: PMC7061678 DOI: 10.1016/j.jpra.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022] Open
Abstract
The presence of mammary nodules during childhood and adolescence is somewhat unusual, generally consisting of benign lesions. Despite the range of possible diagnoses, they are generally similar in clinical terms. In the rare cases where these lesions constitute a case of gigantomastia, the differential diagnosis must be between juvenile fibroadenomatosis, phyllodes tumours and other even less common diseases of the mammary gland, such as Pseudoangiomatous Stromal Hyperplasia (PASH). This is caused by the exacerbated proliferation of mature fibroblasts and myofibroblasts, with the trigger factor still unknown. This study reports on a rare case of bilateral PASH in a young patient, describing its diagnosis and the surgical technique used.
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Affiliation(s)
- Isadora Morone
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Brazil
| | | | - Paola Soares Cardoso
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Brazil
| | | | - Flávia Clímaco
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Brazil
| | - João Medeiros
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Brazil
| | - Diogo Franco
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Brazil
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18
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Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic, inflammatory disease characterized by painful nodules, abscesses, and sinuses in the intertriginous areas, with significant associated comorbidities. The pathogenesis remains unclear, although advances have been made in understanding the disease process. Management of the disease is challenging, with a wide range of treatment options available with variable clinical response. Areas covered: This review discusses the most updated studies on the complex pathogenic mechanisms of hidradenitis suppurativa and the relevant literature on the current treatment options for this condition. Expert commentary: There is increasing evidence supporting the role of Th17 cells and enhanced expression of IL-17 and IL-1β, which represent potential targets for therapy. Bacteria and biofilms are likely contributory but secondary drivers of inflammation. There is also evolving evidence to suggest the presence of systemic comorbidities associated with HS, which underlie the importance of better understanding the pathogenesis and treatment of this disease.
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Affiliation(s)
- Deborah Negus
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , NC , USA
| | - Christine Ahn
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , NC , USA
| | - William Huang
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , NC , USA
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19
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Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a complex neutrophilic dermatosis that can occur as an idiopathic disease, in association with systemic conditions such as inflammatory bowel disease, as part of an inherited inflammatory syndrome. It can be challenging to treat, as it occurs in a wide variety of clinical settings and there is a lack of a standardized treatment approach. The main limitations to treatment have been an incomplete understanding of the pathogenesis. However, recent advances have been made in understanding the pathogenesis of this condition, and PG is now considered an autoinflammatory disease process. Areas covered: This review discusses the newest studies that further define our understanding of this disease and the relevant literature on treatment options for pyoderma gangrenosum. Expert commentary: The presence of abnormal neutrophils and T-cells lead to immune dysregulation, leading to lesions of PG. Increased levels of inflammatory mediators including IL-1β, IL-8, IL-17, and TNF-α contribute to the development of the disease but there are still several unknown factors, including the trigger for immune dysregulation and additional contributory components of the immune system. We provide our approach to the management of PG lesions, which involves a multi-faceted approach including wound care, topical therapy, and systemic medications in most cases.
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Affiliation(s)
- Christine Ahn
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , North Carolina , USA
| | - Deborah Negus
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , North Carolina , USA
| | - William Huang
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , North Carolina , USA
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20
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Sun NZ, Ro T, Jolly P, Sayed CJ. Non-response to Interleukin-1 Antagonist Canakinumab in Two Patients with Refractory Pyoderma Gangrenosum and Hidradenitis Suppurativa. J Clin Aesthet Dermatol 2017; 10:36-38. [PMID: 29344326 PMCID: PMC5749618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pyoderma gangrenosum and hidradenitis suppurativa are skin conditions characterized by an intense neutrophil-mediated inflammatory response that is often difficult to effectively treat. Successful use of interleukin (IL)-1β inhibition using canakinumab and anakinra has been reported in patients with concomitant pyoderma gangrenosum and hidradenitis suppurativa. We report two cases where targeted therapy with canakinumab failed to lead to improvement for patients with pyoderma gangrenosum and hidradenitis suppurativa. The reason behind the non-response to IL-1β blockade seen in these patients is unclear. Our report suggests that further controlled studies are warranted to help clinicians predict treatment responses to anti-IL-1 therapies in these challenging patients.
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Affiliation(s)
- Natalie Z Sun
- All authors are with the University of North Carolina at Chapel Hill, Dermatology, in Chapel Hill, North Carolina
| | - Teresa Ro
- All authors are with the University of North Carolina at Chapel Hill, Dermatology, in Chapel Hill, North Carolina
| | - Puneet Jolly
- All authors are with the University of North Carolina at Chapel Hill, Dermatology, in Chapel Hill, North Carolina
| | - Christopher J Sayed
- All authors are with the University of North Carolina at Chapel Hill, Dermatology, in Chapel Hill, North Carolina
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21
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Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a breast stromal change, histologically characterized by anastomosing, slit-like spaces lined by slender myofibroblasts and surrounded by dense collagenous stroma. Mass forming cases clinically and radiologically simulate fibroadenoma. A middle aged women presented with unpalpable breast nodule discovered on ultrasound examination. The ultrasound characteristics were typical for fibroadenoma, while fine-needle aspiration cytology was inconclusive. The histological examination of the lumpectomy specimen showed fibroadenoma with peculiar stromal alteration consistent with pseudoangiomatous stromal hyperplasia. The presented case of fibroadenoma with pseudoangiomatous hyperplasia within its stroma demonstrates the relationship between these two entities not only clinically and radiologically, but also histologically.
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22
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Johnson HM, Reisler T. Pseudoangiomatous stromal hyperplasia presenting as accessory axillary breast tissue. Eplasty 2017; 17:ic19. [PMID: 28900530 PMCID: PMC5522831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Tom Reisler
- bDivision of Plastic and Reconstructive Surgery, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, NC,Correspondence:
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23
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Krawczyk N, Fehm T, Ruckhäberle E, Mohrmann S, Riemer J, Braunstein S, Hoffmann J. Bilateral Diffuse Pseudoangiomatous Stromal Hyperplasia ( PASH) Causing Gigantomastia in a 33-Year-Old Pregnant Woman: Case Report. Breast Care (Basel) 2016; 11:356-358. [PMID: 27920630 DOI: 10.1159/000450867] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferation of mammary stroma mostly described as an incidental microscopic finding. Clinically, it can manifest as a palpable, well-circumscribed breast mass or in rare cases as a diffuse bilateral process causing massive breast enlargement. The most postulated theory for aetiology of this condition is hormonal stimulation of mammary myofibroblasts, particularly by progesterone. A definite diagnosis of PASH is based on typical pathological findings like stromal hyperplasia and empty slit-like channels positive for myofibroblastic and negative for endothelial markers. The main clinical differential diagnosis is a fibroadedoma or phylloid tumour, and histologically a low-grade angiosarcoma. There are less than 200 cases of tumorous PASH and less than 20 of diffuse PASH reported so far. Here we present a case report of huge diffuse PASH, that is, to our knowledge, the first in a pregnant woman.
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Affiliation(s)
- Natalia Krawczyk
- Department of Obstetrics and Gynaecology, Heinrich-Heine University, Düsseldorf, Germany, Düsseldorf, Germany
| | - Tanja Fehm
- Department of Obstetrics and Gynaecology, Heinrich-Heine University, Düsseldorf, Germany, Düsseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Obstetrics and Gynaecology, Heinrich-Heine University, Düsseldorf, Germany, Düsseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Obstetrics and Gynaecology, Heinrich-Heine University, Düsseldorf, Germany, Düsseldorf, Germany
| | - Jasmin Riemer
- Department of Pathology, Heinrich-Heine University, Düsseldorf, Germany
| | - Stefan Braunstein
- Department of Pathology, Heinrich-Heine University, Düsseldorf, Germany
| | - Jürgen Hoffmann
- Department of Obstetrics and Gynaecology, Heinrich-Heine University, Düsseldorf, Germany, Düsseldorf, Germany
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24
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Kelten Talu C, Boyaci C, Leblebici C, Hacihasanoglu E, Bozkurt ER. Pseudoangiomatous Stromal Hyperplasia in Core Needle Biopsies of Breast Specimens. Int J Surg Pathol 2016; 25:26-30. [PMID: 27450985 DOI: 10.1177/1066896916660763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudoangiomatous stromal hyperplasia (PASH) is a benign lesion of myofibroblasts that is composed of a network of slit-like channels that resemble vascular spaces. The aims of this study were to document the frequency of PASH in core needle biopsy specimens (CNBS) of the breast, to describe which histopathologic findings coexist with PASH and to examine any endothelial cell differentiation. MATERIALS AND METHODS We reevaluated hematoxylin and eosin-stained sections of all CNBS that were obtained during a 1-year period. First, we performed CD34 and CD31 immunostainings to highlight the areas of PASH, then performed D2-40/podoplanin (lymphatic endothelial marker) and Fli-1 (vascular endothelial cell marker) immunostains. RESULTS The total number of CNBS was 412. Areas of PASH were noted in 37 of the 412 cases (9%), with a mean age of 38.5 years. The lesions that were described in association with PASH were "benign breast parenchyma with stromal fibrosis" (17/37; 46%), "fibroepithelial tumors" (17/37; 46%), "columnar cell changes (CCC)" (2/37; 5%), and "invasive carcinoma" (1/37; 3%). There were 2 cases of CCC within the foci of PASH (direct contact with PASH), and 8 additional cases of CCC that coexisted in the same specimen but were not in direct contact. There was no staining for D2-40 or Fli-1 within PASH foci. CONCLUSION PASH lesions occurred with a frequency of 9% in CNBS and were mostly in association with benign breast lesions in premenopausal women. CCC was determined as an accompanying epithelial lesion within or near PASH areas. No obvious immunopositivity compatible with endothelial cell differentiation was revealed.
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Affiliation(s)
- Canan Kelten Talu
- 1 Istanbul Research and Training Hospital, Pathology Department, Fatih, Istanbul, Turkey
| | - Ceren Boyaci
- 1 Istanbul Research and Training Hospital, Pathology Department, Fatih, Istanbul, Turkey
| | - Cem Leblebici
- 1 Istanbul Research and Training Hospital, Pathology Department, Fatih, Istanbul, Turkey
| | - Ezgi Hacihasanoglu
- 1 Istanbul Research and Training Hospital, Pathology Department, Fatih, Istanbul, Turkey
| | - Erol Rustu Bozkurt
- 1 Istanbul Research and Training Hospital, Pathology Department, Fatih, Istanbul, Turkey
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25
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Talu CK, Çakır Y, Hacıhasanoğlu E, Leblebici C, Aksoy Ş, Nazlı MA. Inflammatory Myofibroblastic Tumor of the Breast Coexisting with Pseudoangiomatous Stromal Hyperplasia. J Breast Health 2016; 12:171-173. [PMID: 28331757 DOI: 10.5152/tjbh.2016.3079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/15/2016] [Indexed: 01/29/2023]
Abstract
Inflammatory myofibroblastic tumors (IMTs) are uncommon breast lesions that consist of spindle cells accompanied by plasma cell-rich inflammatory infiltration, which may mimic breast cancer clinico-radiologically. A woman aged 38 years with a breast mass was referred to our general surgery clinic. The physical examination revealed a mass with irregular borders in the upper outer quadrant of the left breast. In mammography, the lesion was 15 mm in diameter with a spheric form and high density. Ultrasonographically, the mass was solid, heterogeneous, and hypoechoic with posterior enhancement. Histopathologic examination of a core needle biopsy revealed a proliferation of spindle cells with eosinophilic cytoplasm and mild nuclear atypia, which showed negative immunostaining for pancytokeratin, HMWCK, CAM5.2, p63, CD34, β-catenin, and ALK but diffuse positivity for smooth muscle alpha (SMA). The lesion was reported as a "spindle cell lesion" and excision with clear margins was recommended. In the lumpectomy specimen, the lesion consisted of spindle cells that formed fascicles and infiltrated the surrounding breast parenchyma. Lymphocytes and plasmocytes scattered among spindle cells were noted. Necrosis, increased mitotic activity, nuclear pleomorphism and hyperchromasia were not detected. Immunohistochemical findings were the same in the core needle biopsy. The Ki-67 proliferation index was below 5%. With these findings, differential diagnoses were ruled out and the tumor was reported as IMT. In close proximity to this lesion, areas of columnar cell lesion with atypia and surrounding pseudoangiomatous stromal hyperplasia were seen. Patient has a follow-up of 16 months without recurrence.
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Affiliation(s)
- Canan Kelten Talu
- Clinic of Pathology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Yasemin Çakır
- Clinic of Pathology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Ezgi Hacıhasanoğlu
- Clinic of Pathology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Cem Leblebici
- Clinic of Pathology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Şefika Aksoy
- Clinic of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Ali Nazlı
- Clinic of Radiology, İstanbul Training and Research Hospital, İstanbul, Turkey
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26
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Abstract
Diagnosis of pyoderma gangrenosum in 2014 continues to be made on clinical grounds, with the main form comprising an ulcer having poorly delineated purplish edges. The diagnostic criteria have been recently modified so as to rule out differential diagnoses (10% of retrospective series of pyoderma patients). The condition is commonly associated with other diseases (75%) such as emerging endocrine diseases (36.7%), and classical gastrointestinal, rheumatological and haematological diseases. The new concepts of PAPA and PASH syndromes, belonging to the category of auto-inflammatory diseases, provide new therapeutic perspectives. Corticosteroids continue to be the first-line therapy, along with immunosuppressant drugs in the event of steroid dependence. Second-line treatments consisting biotherapies show promise and interleukin-1 inhibitors have exhibited potential against pyoderma syndrome.
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Affiliation(s)
- P Modiano
- Service de dermatologie, université catholique de Lille, hôpital Saint-Vincent-de-Paul, boulevard de Belfort, BP 387, 59020 Lille, France.
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27
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Abstract
IL-1 is a master cytokine of local and systemic inflammation. With the availability of specific IL-1 targeting therapies, a broadening list of diseases has revealed the pathologic role of IL-1-mediated inflammation. Although IL-1, either IL-1α or IL-1β, was administered to patients in order to improve bone marrow function or increase host immune responses to cancer, these patients experienced unacceptable toxicity with fever, anorexia, myalgias, arthralgias, fatigue, gastrointestinal upset and sleep disturbances; frank hypotension occurred. Thus it was not unexpected that specific pharmacological blockade of IL-1 activity in inflammatory diseases would be beneficial. Monotherapy blocking IL-1 activity in a broad spectrum of inflammatory syndromes results in a rapid and sustained reduction in disease severity. In common conditions such as heart failure and gout arthritis, IL-1 blockade can be effective therapy. Three IL-1blockers have been approved: the IL-1 receptor antagonist, anakinra, blocks the IL-1 receptor and therefore reduces the activity of IL-1α and IL-1β. A soluble decoy receptor, rilonacept, and a neutralizing monoclonal anti-interleukin-1β antibody, canakinumab, are also approved. A monoclonal antibody directed against the IL-1 receptor and a neutralizing anti-IL-1α are in clinical trials. By specifically blocking IL-1, we have learned a great deal about the role of this cytokine in inflammation but equally important, reducing IL-1 activity has lifted the burden of disease for many patients.
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Key Words
- AOSD
- Autoimmune
- Autoinflammatory
- C-reactive protein
- CAPS
- CRP
- DIRA
- FCAS
- FMF
- HIDS
- Inflammation
- NLRP12
- NLRP3
- NOMID
- PAPA
- PASH
- PFAPA
- SAPHO
- SJIA
- TNF receptor associated periodic syndrome
- TRAPS
- adult onset Still's disease
- cryopyrin autoinflammatory periodic syndromes
- deficiency of IL-1Ra
- familial Mediterranean fever
- familial cold autoinflammatory syndrome
- hyper IgD syndrome
- neonatal onset multi-inflammatory diseases
- nucleotide-binding domain and leucine-rich repeat pyrin containing 12
- nucleotide-binding domain and leucine-rich repeat pyrin containing 3
- periodic fever, aphthous stomatitis, pharyngitis, and adenitis
- pyoderma-gangrenosum, acne, and suppurativa hidradenitis
- pyogenic arthritis, pyoderma gangrenosum, and acne
- synovitis, acne, pustulosis, hyperostosis and osteitis
- systemic-onset juvenile idiopathic arthritis
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Affiliation(s)
- Charles A Dinarello
- Department of Medicine, University of Colorado Denver, Aurora, CO, United States; Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos W M van der Meer
- Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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