BREAST COMMITTEE FOGSI

1. BREAST MASSES
IN CHILDREN AND
ADOLESCENTS
DR. KAWITA BAPAT BREAST
COMMITTEE FOGSI

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
(witch’s 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 > 5cm
or persists to adulthood, excisional biopsy is
warranted.

12. GIANT FIBROADENOMA
 Grow rapidly to >5cm.
 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 d’orange)
 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