BREAST MASSES
IN CHILDREN AND
ADOLESCENTS
BREAST MASSES
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The majority of the breast masses in children
and adolescents are benign and self limited.
The finding of a breast mass is very
disconcerting to the patient and her family.
CAUSES
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NEONATES
Breast hypertrophy due to stimulation from
maternal hormones.
Occurs in both males and females.
Sometimes associated with a milky discharge
(witch’s milk).
Resolves spontaneously within 2,weeks in
boys and several months in girls.
Mastitis or breast abscess.
CAUSES IN PREPUBERTAL
AND PUBERTAL CHILDREN
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Usually breast buds.
In pubertal children is usually the first sign of
puberty.
In prepubertal children may indicate
premature thelarche or precocious puberty.
Hemangiomas and lymphangiomas,dx.
Clinically.
CAUSES IN ADOLESCENTS
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Usually self limited and benign.
Fibrocystic disease
Fibroadenoma
Breast trauma
Breast infection
FIBROCYSTIC DISEASE
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More common in adolescents
Cause is not known
Maybe an imbalance between estrogen and
progestrone
Caffeine may worsen the symptoms
Painful breast tissue before menstruation
Generally in the upper outer quadrants
Green or brown discharge maybe present
Fibrocystic disease cont.
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TREATMENT
Analgesia
Oral contraceptives
Elemination of caffeine
FIBROADENOMA
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Most common breast lesion in adolescent
Rubbery,well circumscribed and mobile
Usually 2-3 cm
Found in the upper and outer quadrants but
may occur any quadrant.
Recurrent or multiple in 10-25% of cases.
FIBROADENOMA CONT
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Dx. Clinically
Ultrasonography or needle aspiration maybe
used.
A solid well circumscribed avascular mass in
the u/s.
Mammography is not indicated in
adolescents,since the large amount of
glandular tissue is difficult to interpret.
FIBROADENOMA CONT
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All lesions less than 5 cm can be safely
observed with serial examination
If there is growth in the lesion, size is > 5cm
or persists to adulthood, excisional biopsy is
warranted.
GIANT FIBROADENOMA
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Grow rapidly to >5cm.
May compress normal breast tissue
Should be excised.
Cannot be distinguished from phyllodes
tumors by P.E. Ultrasonography or
mammography.
PHYLLODES TUMOR
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Rare primary tumor
Occurs in older women
Has been reported in girls as young as 10 years
Diverse range of behavior
Usually presents as a large painless breast mass
Bloody discharge maybe present
Recommended treatment is excision
Radical measures if malignant
INTRADUCTAL PAPILLOMA
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Rare benign tumor
From the proliferation of mammary duct
epithelium
Presents clinically as bloody discharge or
breast enlargement
Maybe bilateral
Well circumscribed nodules palpated under
the areola or in the periphery of the breast
Treated by excision
MAMMARY DUCT ECTASIA
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Distention of subareolar ducts with fibrosis
and inflammation
Multicolored sticky discharge.
May appear as a blue mass under the nipple
if the fluid in the cyst is dark in color
Excision is diagnostic and is curative
MONTGOMERY TUBERCLES
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Small tubercles at the edge of the areola
Obstruction may lead to acute inflammation
Dx. Clinically.
Cysts are observed with serial examination
and ultrasonography.
Over 80% resolve in weeks to months,may
take upto 2,years.
BREAST TRAUMA
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Direct blow may cause fat necrosis
This can resemble a solid mass.
Clinically and radiographically fat necrosis
can mimic malignancy.
PRIMARY BREAST CANCER
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Rare in children and adolescents.
Juvenile secretory carcinoma is most
common.
Followed by intraductal carcinoma.
Rhabdomyosarcoma and lymphoma can
also occur as a primary lesion
CANCER CONT
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The most common finding is a hard irregular
mass.
May or may not be fixed.
Skin or nipple retraction.
Skin edema (peau d’orange)
Nipple involvement and nipple discharge.
Axillary and supraclavicular
lymphadenopathy.
HISTORY important aspects
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Duration
Associated symptoms
Previous breast disease
Previous or present malignancy or hx.of irradiation
Chronology of the development of secondary sexual
characters
Menstrual history
Pregnancy
Medication
Family history
EXAMINATION-important
aspects
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Location
Consistency
Size
Mobility
Tenderness
Overlying skin changes
Nipple discharge
Appearance of the nipple
Lymphadenopathy
hepatosplenomegaly