This document discusses breast masses in children and adolescents. The majority of breast masses in these groups are benign and self-limited. Common benign causes include breast hypertrophy in neonates, breast buds in pubertal children, fibrocystic disease, and fibroadenomas in adolescents. Rarely, breast cancer can occur. Evaluation involves history, examination, and possibly ultrasound or biopsy. Treatment depends on diagnosis but most benign masses require only observation.

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