BREAST MASSES IN CHILDREN AND ADOLESCENTS

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BREAST MASSESIN CHILDREN AND ADOLESCENTS
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BREAST MASSES

• 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.

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CAUSES

• NEONATES
• Breast hypertrophy due to stimulation from
  maternal hormones.
• Occurs in both males and females.
• Sometimes associated with a milky discharge
  (witchs milk).
• Resolves spontaneously within 2,weeks in boys and
  several months in girls.
• Mastitis or breast abscess.

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CAUSES IN PREPUBERTAL AND PUBERTAL CHILDREN

• 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.

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CAUSES IN ADOLESCENTS

• Usually self limited and benign.
• Fibrocystic disease
• Fibroadenoma
• Breast trauma
• Breast infection

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FIBROCYSTIC DISEASE

• 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

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Fibrocystic disease cont.

• TREATMENT
• Analgesia
• Oral contraceptives
• Elemination of caffeine

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FIBROADENOMA

• 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.

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FIBROADENOMA CONT

• 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.

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FIBROADENOMA CONT

• All lesions less than 5 cm can be safely observed
  with serial examination
• If there is growth in the lesion, size is gt 5cm
  or persists to adulthood, excisional biopsy is
  warranted.

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GIANT FIBROADENOMA

• Grow rapidly to gt5cm.
• May compress normal breast tissue
• Should be excised.
• Cannot be distinguished from phyllodes tumors by
  P.E. Ultrasonography or mammography.

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PHYLLODES TUMOR

• 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

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INTRADUCTAL PAPILLOMA

• 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

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MAMMARY DUCT ECTASIA

• 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

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MONTGOMERY TUBERCLES

• 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.

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BREAST TRAUMA

• Direct blow may cause fat necrosis
• This can resemble a solid mass.
• Clinically and radiographically fat necrosis can
  mimic malignancy.

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PRIMARY BREAST CANCER

• 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

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CANCER CONT

• The most common finding is a hard irregular mass.
• May or may not be fixed.
• Skin or nipple retraction.
• Skin edema (peau dorange)
• Nipple involvement and nipple discharge.
• Axillary and supraclavicular lymphadenopathy.

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HISTORY important aspects

• 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

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EXAMINATION-important aspects

• Location
• Consistency
• Size
• Mobility
• Tenderness
• Overlying skin changes
• Nipple discharge
• Appearance of the nipple
• Lymphadenopathy
• hepatosplenomegaly