A rare incidence of pseudoangiomatous stromal hyperplasia (PASH) in a senior adult male: a case report highlighting a novel presentation.

Background: Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign mesenchymal lesion of the breast that is most commonly seen in young premenopausal and perimenopausal females and found in approximately 23% of breast specimens. In rare cases, PASH has been reported exclusively in young adult males and is associated with gynecomastia. The prevalence of benign breast masses in men with gynecomastia ranges from approximately 23.8-47.4% and peaks between the ages of 50 and 80. PASH frequently presents as a palpable mass or is incidentally identified through imaging and microscopy. Due to its varied and infrequent presentations, PASH is often mistaken for malignancy or other breast lesions, particularly in senior adult males (over 65 years old), an age group commonly affected by benign breast masses and male breast cancer. Given its rare and diverse presentation, it is crucial to consider PASH in the differential diagnosis of a male patient with a benign breast tumor to guide appropriate management, avoid overtreatment, and ensure prompt evaluation for any underlying abnormalities.

Case presentation: This report presents a unique case of PASH in a senior adult male, aged over 65 years, who presented with an enlarging palpable areolar mass. Notably, the patient had no family history or past medical history of breast cancer. Imaging studies, including mammography and ultrasound, revealed mild gynecomastia and BIRADS-4 classification, prompting further investigation. A core needle biopsy confirmed the diagnosis of PASH, showing no evidence of carcinoma or malignancy. Given the mass's progressive enlargement, surgical excision was recommended and successfully performed.

Conclusions: This report outlines the patient's clinical presentation, diagnostic evaluation, and management while also providing a brief review of the limited literature. It is the first report to describe the presentation and management of PASH in a male over 65 years old with no history of abnormal breast pathology. Understanding atypical cases of PASH is essential for accurate diagnosis and appropriate management in this patient demographic.