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BREAST MASSES IN CHILDREN AND ADOLESCENTS

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In pubertal children is usually the first sign of puberty. In prepubertal children may indicate premature thelarche or precocious puberty. – PowerPoint PPT presentation

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Title: BREAST MASSES IN CHILDREN AND ADOLESCENTS


1
BREAST MASSESIN CHILDREN AND ADOLESCENTS
2
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3
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.

4
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.

5
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.

6
CAUSES IN ADOLESCENTS
  • Usually self limited and benign.
  • Fibrocystic disease
  • Fibroadenoma
  • Breast trauma
  • Breast infection

7
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

8
Fibrocystic disease cont.
  • TREATMENT
  • Analgesia
  • Oral contraceptives
  • Elemination of caffeine

9
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.

10
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.

11
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.

12
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.

13
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

14
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

15
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

16
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.

17
BREAST TRAUMA
  • Direct blow may cause fat necrosis
  • This can resemble a solid mass.
  • Clinically and radiographically fat necrosis can
    mimic malignancy.

18
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

19
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.

20
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

21
EXAMINATION-important aspects
  • Location
  • Consistency
  • Size
  • Mobility
  • Tenderness
  • Overlying skin changes
  • Nipple discharge
  • Appearance of the nipple
  • Lymphadenopathy
  • hepatosplenomegaly
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