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Background: Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast. Only a few cases have been reported in the literature. The pathogenesis of PASH is still not known however, there is evidence to support hormonal stimulation of mammary fibroblasts. Most cases of PASH present as a unilateral, palpable breast mass in a perimenopausal female; rarely does it present as a diffuse process bilaterally in a child. Further, PASH is diagnosed histologically and can be seen with a variety of other benign and malignant breast processes such as fibroadenoma and angiosarcoma. Current management of PASH favors excisional biopsy versus observation. Since most patients are perimenopausal and have finished breast development, treatment for peri-pubescent patients is not commonly described in the literature. Case Description: We present a case of bilateral PASH in a 12-year-old African American female, pre-menstrual and Tanner stage II. The right breast grew rapidly over the course of four weeks followed by left breast hypertrophy about 2 months later. Both breasts underwent a core needle biopsy (CNB) that resulted as a juvenile fibroadenoma. Both breasts were treated with surgical excisional biopsy and then histologically diagnosed with PASH. Postoperatively bilateral nipples showed patches of hypopigmentation. At 6 months postoperatively, clinical recurrence of PASH was not observed in either breast. Conclusions: PASH is a rare breast pathology usually diagnosed in perimenopausal females. Excisional biopsy is the standard surgical approach for a unilateral, palpable lesion. Our pediatric patient was peri-pubescent with diffuse bilateral disease treated with bilateral excisional biopsies. Recurrence of PASH and natural development of breasts are yet to be determined for our patient.