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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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Presentation Transcript
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