Breast masses in children and adolescents
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BREAST MASSES IN CHILDREN AND ADOLESCENTS. 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. . CAUSES. NEONATES

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Breast masses in children and adolescents

BREAST MASSESIN CHILDREN AND ADOLESCENTS


Breast masses
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.


Causes
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.


Causes in prepubertal and pubertal children
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.


Causes in adolescents
CAUSES IN ADOLESCENTS

  • Usually self limited and benign.

  • Fibrocystic disease

  • Fibroadenoma

  • Breast trauma

  • Breast infection


Fibrocystic disease
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


Fibrocystic disease cont
Fibrocystic disease cont.

  • TREATMENT

  • Analgesia

  • Oral contraceptives

  • Elemination of caffeine


Fibroadenoma
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.


Fibroadenoma cont
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.


Fibroadenoma cont1
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.


Giant fibroadenoma
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.


Phyllodes tumor
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


Intraductal papilloma
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


Mammary duct ectasia
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


Montgomery tubercles
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.


Breast trauma
BREAST TRAUMA

  • Direct blow may cause fat necrosis

  • This can resemble a solid mass.

  • Clinically and radiographically fat necrosis can mimic malignancy.


Primary breast cancer
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


Cancer cont
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.


History important aspects
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


Examination important aspects
EXAMINATION-important aspects

  • Location

  • Consistency

  • Size

  • Mobility

  • Tenderness

  • Overlying skin changes

  • Nipple discharge

  • Appearance of the nipple

  • Lymphadenopathy

  • hepatosplenomegaly


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