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Lo AC, Ronckers C, Aznar MC, Avanzo M, van Dijk I, Kremer LCM, Gagliardi G, Howell RM, Rancati T, Constine LS, Marcus KJ. Breast Hypoplasia and Decreased Lactation From Radiation Therapy in Survivors of Pediatric Malignancy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:549-559. [PMID: 34627655 DOI: 10.1016/j.ijrobp.2021.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Breast hypoplasia and impaired lactation are poorly studied sequelae of chest radiation therapy (RT) in children. The Pediatric Normal Tissue Effects in the Clinic female breast task force aimed to quantitate the radiation dose-volume effects on these endpoints. METHODS AND MATERIALS A literature search was conducted of peer-reviewed manuscripts evaluating breast hypoplasia and lactation after chest RT in children, yielding 789 abstracts. Only 2 studies on children irradiated at <4 years of age for angioma of the breast provided dosimetric data correlated with breast hypoplasia. For patients who received brachytherapy, the dose was converted to external beam RT in equivalent 2 Gy fractions (DEBRT), although the limitations of this type of mathematical conversion need to be recognized. We calculated relative risks (RR) and 95% confidence intervals (95% CIs) based on these data. Only 1 study was relevant to the lactation endpoint, in which patients were given RT for Hodgkin lymphoma at age 14 to 40 years. RESULTS The 3 studies involved 206 patients in total. In patients <4 years old at the time of RT, the prevalence of patient-perceived breast hypoplasia was 38% (RR 2.5; 95% CI, 1.3-4.6) after DEBRT of <0.34 Gy, 61% (RR 4.0; 95% CI, 2.1-7.4) after DEBRT 0.34-0.97 Gy, and 97% (RR 6.3; 95% CI, 3.6-10.8) after DEBRT ≥0.97 Gy to the breast anlage. A simple linear regression model (r = 0.72; P < .001) showed that the treated breast was smaller than the untreated breast by 13% at DEBRT = 0.5 Gy, 20% at DEBRT = 1 Gy, 32% at DEBRT = 2 Gy, 51% at DEBRT = 4 Gy, 66% at DEBRT = 6 Gy, 79% at DEBRT = 8 Gy, and 90% at DEBRT = 10 Gy. The risk of unsuccessful breastfeeding was 39% after a median mediastinal dose of 41 Gy, compared with 21% in a sibling control group (P = .04). RT dose of ≥42 Gy was not associated with less breastfeeding success compared with <42 Gy, and data on lower doses were unavailable. CONCLUSIONS Based on extremely limited data, young adults exposed to thoracic RT as children seem to be at significant risk of breast hypoplasia and impaired lactation. Doses as low as 0.3 Gy to immature breasts can cause breast hypoplasia. Additional studies are needed to quantify dose and technique effects with modern RT indications. Prospective collection of clinical outcomes and dosimetric factors would enhance our understanding of RT-induced breast hypoplasia and impaired lactation.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada.
| | - Cecile Ronckers
- Department of Pediatric Oncology, Prinses Maxima Centrum, Utrecht, the Netherlands
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Irma van Dijk
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatrics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Giovanna Gagliardi
- Department of Medical Physics, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
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Labow BI, Alshamekh SA, Carlberg VM, Zacur JL, Uihlein LC, Mulliken JB, Liang MG. Infantile Hemangioma of the Breast: Long-Term Assessment of Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5506. [PMID: 38196847 PMCID: PMC10773794 DOI: 10.1097/gox.0000000000005506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/24/2023] [Indexed: 01/11/2024]
Abstract
Background The literature is meager regarding the natural history and outcomes of infantile hemangiomas (IHs) in the breast. Treatment in childhood may be considered due to psychosocial and physical concerns with breast development. Early surgical intervention may cause iatrogenic breast asymmetry and possibly impair lactation later in life. This study characterizes the clinical presentation, management, and long-term outcomes of IHs arising in the breast. Methods Female patients aged 11 years or older at presentation were included in a retrospective review of the Vascular Anomalies Center database for patients with IHs of the breast seen at our institution between 1980 and 2020. Breast development was ascertained by a structured telephone interview, physical examination, or photographs. Results A total of 10 patients met criteria for inclusion in this study. The median age at enrollment was 14 years (11-36 years). Breast asymmetry was noted in 60% of patients (n = 6). Of the four patients who underwent subtotal excision of breast IH, three developed ipsilateral breast hypoplasia. Breast asymmetry was also noted in three of five patients who did not receive medical treatment: two with hypoplasia and one with hyperplasia. No asymmetry was noted in the single patient who received corticosteroid. Conclusions IHs involving the nipple-areola complex can be associated with breast asymmetry. Hypoplasia was noted in patients not treated with corticosteroid or resection in childhood. These findings suggest that systemic treatment should be considered. Longitudinal follow-up on patients treated with propranolol will elucidate its possible benefits in minimizing breast asymmetry.
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Affiliation(s)
- Brian I. Labow
- From the Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Shomoukh A. Alshamekh
- From the Harvard Medical School, Boston, Mass
- Dermatology Program, Boston Children’s Hospital, Boston, Mass
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Valerie M. Carlberg
- From the Harvard Medical School, Boston, Mass
- Dermatology Program, Boston Children’s Hospital, Boston, Mass
- Dermatology Program, Children’s Hospital Wisconsin, Milwaukee, Wis
| | - Jennifer L. Zacur
- From the Harvard Medical School, Boston, Mass
- Dermatology Program, Boston Children’s Hospital, Boston, Mass
- St Joseph Mercy Chelsea Hospital, Chelsea, Mich
| | - Lily C. Uihlein
- From the Harvard Medical School, Boston, Mass
- Dermatology Program, Boston Children’s Hospital, Boston, Mass
- Department of Dermatology, Kaiser Permanente, Petaluma, Calif
| | - John B. Mulliken
- From the Harvard Medical School, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Marilyn G. Liang
- From the Harvard Medical School, Boston, Mass
- Dermatology Program, Boston Children’s Hospital, Boston, Mass
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Marlor DR, Briggs KB, Stewart S, Cruz-Centeno N, Dekonenko C, Oyetunji TA, Fraser JD. Persistent Pediatric Breast Abscesses Following Initial Treatment at Tertiary and Community Centers. J Surg Res 2023; 292:65-71. [PMID: 37595515 DOI: 10.1016/j.jss.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Little data exist on the management of pediatric breast abscesses that fail initial treatment. Therefore, this study aimed to evaluate and report outcomes in these patients. METHODS All patients <18-year-old treated for a breast abscess between January 2008 and December 2018 were included. Patients were divided into two groups: initial treatment at our institution (Group 1) and initial treatment at referring centers (Group 2). The primary outcome was disease persistence following treatment at our institution. Secondary outcomes included treatment modalities and patient characteristics. RESULTS In total, 145 patients were identified: 111 in Group 1 and 34 in Group 2. Antibiotics alone were the initial treatment in 52.3% (n = 58) of Group 1 patients and 64.7% (n = 22) of Group 2 patients. Invasive treatment was more common in Group 1 (45.9% vs 5.8%; P < 0.00001). Patients with persistent disease in Group 1 were treated with aspiration (n = 7, 50%), incision and drainage (n = 5, 35.7%), antibiotics (n = 1, 7.14%), and manual expression (n = 1, 7.14%.), while Group 2 patients were treated with antibiotics (50%, n = 17), aspiration (26.47%, n = 9), incision and drainage (17.65%, n = 6), and manual expression (5.88%, n = 2). Group 2 patients with persistent disease were more likely to be treated with antibiotics or a change in antibiotics (50% vs 7.14%; P = 0.005). Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%). CONCLUSIONS Persistent breast abscesses may be treated with antibiotics in appropriate cases. Damage to the developing breast bud should be minimized. Disease persistence is similar once treated at tertiary care centers.
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Affiliation(s)
- Derek R Marlor
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri.
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Szar M, Dendy CB, Hillenbrand K. Breast Conditions (Disorders) in Children. Pediatr Rev 2023; 44:665-667. [PMID: 37907414 DOI: 10.1542/pir.2022-005534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Madison Szar
- Brody School of Medicine at East Carolina University, Greenville, NC
- ECU Health Medical Center, Greenville, NC
| | - Colby B Dendy
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Karin Hillenbrand
- Brody School of Medicine at East Carolina University, Greenville, NC
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Suhail D, Faderani R, Kalaskar DM, Mosahebi A. Optimal strategies for addressing developmental breast asymmetry and the significance of symmetrical treatment: A systematic review. J Plast Reconstr Aesthet Surg 2023; 84:582-594. [PMID: 37441855 DOI: 10.1016/j.bjps.2023.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Approximately one quarter of women are affected by asymmetry as a result of abnormal breast development, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. This systematic review aimed to review the available literature on the management of developmental breast asymmetry. METHODS A comprehensive search in MEDLINE, EMBASE, and CENTRAL databases was conducted for primary clinical studies reporting on the management of developmental breast asymmetry from 1962 to November 2022. The primary outcome measures were long-term aesthetic outcomes and patient-reported outcomes. RESULTS Eleven case series and 2 cohort studies were included, comprising a total of 1237 patients with a mean age of 26.5 years (range 14-65 years). Twelve studies (92%) addressed asymmetry through surgical means, using various augmentation and reduction procedures, whereas one study (8%) utilized external prostheses. Meta-analysis of the data was not deemed to be possible because of heterogeneity of data; a narrative synthesis of the literature was provided. CONCLUSIONS There is no consensus on how to manage developmental breast asymmetry. Furthermore, there is a lack of consistency in the classification of patients with developmental breast asymmetry and in the reporting of outcomes, highlighting the need for a consensus. Further research outlining long-term aesthetic and patient-reported outcomes is needed to understand which procedures provide optimal outcomes. In addition, external breast prosthesis is a promising nonsurgical alternative, and further studies into its efficacy are needed.
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Affiliation(s)
- Dernas Suhail
- Hull York Medical School, University of York, York, UK.
| | - Ryan Faderani
- Department of Plastic Surgery, Royal Free Hospitals NHS Trust, London, UK
| | - Deepak M Kalaskar
- UCL Division of Surgery & Interventional Science, Royal Free Hospital, London, UK
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospitals NHS Trust, London, UK
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Harper LK, Simmons CL, Woodard GA, Solanki MH, Bhatt AA. Pictorial Review of Common and Uncommon Pediatric Breast Lesions. Radiographics 2023; 43:e220117. [DOI: 10.1148/rg.220117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura K. Harper
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Curtis L. Simmons
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Genevieve A. Woodard
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Malvika H. Solanki
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Asha A. Bhatt
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
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Norelius R. Juvenile Benign Diseases of the Breast. Surg Clin North Am 2022; 102:1065-1075. [DOI: 10.1016/j.suc.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Xiong J, Hou Q, Hu Z, Gao Y, Lu L, Sun M, Hu H, Qian Y, Wang H, Jiang H. The Application of Anatomy Combined With Ultrasound Knife in Transaxillary Endoscopic Biplane Breast Augmentation. Front Surg 2022; 9:865379. [PMID: 35574545 PMCID: PMC9091814 DOI: 10.3389/fsurg.2022.865379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We aim to clarify the vascular and nerve anatomy of the breast and combine it with an ultrasound knife to use in transaxillary endoscopic biplane breast augmentation. Methods This study is a retrospective review of patients undergoing transaxillary endoscopic biplane breast augmentation between October and October 2021. Related variables were collected using a standardized data collection template. The detailed process of the transaxillary endoscopic biplane breast augmentation under anatomy instruction is carefully described in this study, and the postoperative effect was closely observed. Results Sixty-three female patients underwent transaxillary endoscopic biplane breast augmentation. The average implants volume counted 242.46 ± 31.34 cc, and the average operation time was 155.92 ± 22.34 min. Patients were followed up for a mean of 13.67 months (range, 3-27 months), and most of the patients achieved good postoperative results and no severe complications and were satisfied with both appearance and function. Conclusions The application of anatomy combined with an ultrasound knife in transaxillary endoscopic biplane breast augmentation is a promising way to achieve good breast shapes with high patient satisfaction and is worthy of clinical promotion and application.
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Affiliation(s)
- Jiachao Xiong
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiang Hou
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zheyuan Hu
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yakun Gao
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lu Lu
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Meiqing Sun
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hao Hu
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuxin Qian
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Wang
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hua Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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Differential Diagnosis of a Unique Vulvar Mass in an Adolescent. Obstet Gynecol 2021; 138:931-936. [PMID: 34735404 DOI: 10.1097/aog.0000000000004563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vulvar masses in adolescents have a broad differential diagnosis, yet few reports exist detailing masses of mammary origin. CASE A nulliparous, healthy 16-year-old adolescent presented with a longstanding, ulcerated, 17-cm vulvar mass of unknown origin and pronounced inguinal lymphadenopathy. The patient underwent a left radical partial vulvectomy, with pathology revealing terminal duct lobular units consistent with polymastia. CONCLUSION Differential diagnosis of a vulvar mass in an adolescent should include polymastia.
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Restrepo R, Cervantes LF, Swirsky AM, Diaz A. Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation. Pediatr Radiol 2021; 51:1959-1969. [PMID: 34236480 DOI: 10.1007/s00247-021-05099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/01/2021] [Accepted: 05/02/2021] [Indexed: 10/20/2022]
Abstract
Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA.
| | - Luisa F Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA
| | | | - Alejandro Diaz
- Division of Pediatric Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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Kam RL, Bernhardt SM, Ingman WV, Amir LH. Modern, exogenous exposures associated with altered mammary gland development: A systematic review. Early Hum Dev 2021; 156:105342. [PMID: 33711581 DOI: 10.1016/j.earlhumdev.2021.105342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many women report low milk supply as the reason for premature breastfeeding cessation. Altered mammary gland development may impact a woman's lactation ability. OBJECTIVE This review identifies modern exogenous exposures which alter mammary gland development during embryonic life, puberty and pregnancy. METHODS A systematic review was undertaken whereby Medline, CINAHL and Embase articles published from January 1, 2005 to November 20, 2020 were searched using the keywords puberty or embry* or fetal or foetal or foetus or fetus or pregnan* or gestation* AND "mammary gland development" or "breast development" or "mammary development" or "mammary gland function" or "mammary function" or "insufficient glandular tissue" or "mammary hypoplasia" or "breast hypoplasia" or "mammary gland hypoplasia" or "tubular breast*" or "tuberous breast*" or "glandular tissue" or "breast composition" or "mammary composition" or "mammary gland composition". After initial screening of 1207 records, 60 full texts were assessed for eligibility; 6 were excluded due to lack of information about exposure or outcome, leaving 54 studies. RESULTS The review included results from 52 animal (rats and mice, monkeys, rabbits, sheep, goats pigs and cows) and 2 human studies. Various endocrine disrupting chemicals and an obesogenic diet were found to be associated with altered mammary gland morphology during key development stages. CONCLUSIONS To improve lactation outcomes, future studies need to focus on lactation as the endpoint and be conducted in a standardised manner to allow for a more significant contribution to the literature that allows for better comparison across studies.
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Affiliation(s)
- Renee L Kam
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.
| | - Sarah M Bernhardt
- Discipline of Surgery, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia; Robinson Research Institute, Adelaide Medical School, University of Adelaide, Australia
| | - Wendy V Ingman
- Discipline of Surgery, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia; Robinson Research Institute, Adelaide Medical School, University of Adelaide, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia; Breastfeeding Service, Royal Women's Hospital, Parkville, Victoria, Australia
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Avola E, Giannetta V, Depretto C, Scaperrotta GP. Uncommon site of metastatic neuroblastoma in a 15-year-old girl: case report and description of sonographic and radiographic features. TUMORI JOURNAL 2021; 107:NP59-NP62. [PMID: 33759659 DOI: 10.1177/03008916211002260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most breast masses in children are benign, breast cancer must be considered in the differential diagnosis. The majority are represented by sarcomas and secondary lesions. Literature reports only four cases of neuroblastoma breast metastasis, with no emphasis on radiologic features. Our work aims to furnish a description of radiologic and sonographic features of neuroblastoma metastasis in the breast. CASE DESCRIPTION A 15-year-old girl had a round nodular mass in the outer upper quadrant of the left breast that had rapidly enlarged over the last month. An ultrasound showed two subcutaneous nodules (3.8 cm and 1.3 cm in maximum diameter), with an irregular shape, heterogeneous echogenicity (isohypoechoic), and hyperechoic foci with a posterior acoustic shadow inside. Overall, the features were highly suspicious of secondary malignant lesions. Computed tomographic scan was performed and found a large retroperitoneal mass and multiple mixed secondary lesions to the spine and hip. A 14G core needle biopsy of breast masses was performed and showed a secondary localization of neuroblastoma. CONCLUSIONS In adolescents, metastases are the most frequent cause of malignant breast masses. Ultrasound examination should be preferred as the first imaging tool. For the differential diagnosis of breast metastasis with benign masses, a rapid enlargement, a heterogeneous echogenicity, and intralesional hyperechogenic foci could be considered features of malignancy.
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Affiliation(s)
- Emanuele Avola
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Giannetta
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
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de Vasconcelos Gaspar A, Melo L, Geraldes F, Belo J, Águas F. Breast pathology in adolescence. Breast Dis 2021; 40:269-274. [PMID: 34120893 DOI: 10.3233/bd-201043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Description of breast pathology in adolescents. METHODS A retrospective descriptive study of adolescents who were referred to the Gynecology consultation of a tertiary pediatric hospital for suspected breast pathology, in the period from the 1st June 2011 to the 30th December 2018. RESULTS One hundred and two female adolescents (11 to 18 years old) with suspected breast pathology were referred (6% of the motives for consultation), with confirmation in 58 (56.9%), who were included in the study. The reasons for referral were breast masses (66%), anomalies in breast size or symmetry (29%) and infection (5%). Of breast masses, the most frequent diagnosis was fibroadenoma (76%), followed by fibro-cystic pathology (18%). In most cases, a conservative approach was chosen, with clinical and imaging surveillance. Surgery was required in 29% of these cases. Anomalies in breast size and symmetry were observed in 17 adolescents. Two adolescents were submitted to symmetrization, after 18 years of age. Infectious and inflammatory pathology occurred in three cases: two mastitis and one retroareolar cyst. The approach consisted mainly of antibiotherapy. There were no cases of malignant breast disease. CONCLUSION Lumps or breast masses are the most frequent breast pathology in adolescence, and in the majority of cases surveillance was recommended, as they are a mere sign of hormonal oscillations at this age. Objective examination and/or breast ultrasound are usually enough to make the diagnosis. The approach must be mainly conservative, since malignancy is extremely rare in this age group.
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Affiliation(s)
| | - Luís Melo
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fernanda Geraldes
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Belo
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fernanda Águas
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Alawi A, Hasan M, Harraz MM, Kamr WH, Alsolami S, Mowalwei H, Salem A, Qronfla H. Breast lesions in women under 25 years: radiologic-pathologic correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00209-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The majority of breast lesions in women under 25 years are being benign. Imaging is important for diagnosis and selecting patients for further procedures. Although malignancy is rare in this group of patients, suspected lesions must be biopsied. Imaging is very important in the selection of patients for radiological intervention. Understanding of the clinical, pathologic, and imaging features allows the radiologist to guide proper management of these patients. The aim of this study was to determine the frequency of different breast lesions in symptomatic women under 25 years and the value of radiological imaging in the diagnosis.
Results
This was a retrospective study; a total number of 250 cases with breast lumps under 25 years of age were registered in the PACKS of our institution in the period from January 01, 2017 to December 31, 2018. Two hundred three cases coped with our inclusion criteria that include available histopathological results either by biopsy or after surgery based on their referring physicians decision. Our exclusion criteria were those cases (47) with definite BIRADS 2 lesions with no available pathology reports. Ultrasonography was done to all patients (203 cases) and MRI was performed to 26 cases. All cases were histologically verified; their findings were reviewed and compared to radiological findings.
A total of 203 symptomatic breast lesions were received at the radiological department in women under 25 years; there were 115 (56.7%) benign, 85 (41.9%) cystic, and 3 (1.5%) malignant lumps. The commonest benign lesion was fibroadenoma (104 cases, 51.2%) and all the malignant lesions were invasive ductal carcinoma (IDC) (3 cases, 1.47%). The p value is > 0.05, so there were no differences between examination using the ultrasonography and the MRI imaging compared to histopathological results.
Conclusions
Most breast lesions in young women are benign. Ultrasonography is an essential first imaging modality in the diagnosis of women under 25 years with breast lesions.
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Mareti E, Vatopoulou A, Spyropoulou GA, Papanastasiou A, Pratilas GC, Liberis A, Hatzipantelis E, Dinas K. Breast Disorders in Adolescence: A Review of the Literature. Breast Care (Basel) 2020; 16:149-155. [PMID: 34012369 DOI: 10.1159/000511924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/26/2020] [Indexed: 01/29/2023] Open
Abstract
Background Adolescence is accompanied by a variety of changes in young breast development, which greatly affects the adolescent's psychology and socialization. Summary PubMed, EMBASE, and the Cochrane Library were searched for studies relative to epidemiology, clinical characteristics, diagnosis, and management of all breast disorders in adolescence and their consequences. Development disorders are breast asymmetry, breast atrophy, breast hypoplasia, hypomastia, juvenile breast hypertrophy, and tuberous breast. Breast congenital abnormalities include athelia, amastia, accessory breast tissue, polymastia, polythelia, and congenital disorders of nipples. Breast infections are commonly caused from Gram-positive coccus rather than Gram-negative bacteria. Breast abscess occurs when breast infections are not promptly treated. Nipple discharge is caused by a variety of conditions and should be managed carefully. Fibrocystic changes, cysts, and fibroadenomas are the most common benign masses in adolescence. Primary, secondary, or metastatic breast cancer is extremely rare in adolescence. However, clinicians should include breast cancer in the differential diagnosis of a breast mass in adolescence. Key Messages Clinicians should be aware of all breast disorders that may occur in adolescence. Early diagnosis and treatment will result in the reassurance of adolescents and their families without any detrimental effect on their psychology, sexual behavior, and socialization. Adolescents with breast disorders may require a multidisciplinary approach by a pediatrician, a gynecologist specializing in pediatric-adolescent gynecology, a plastic surgeon, and a psychologist for the best management of breast disorders.
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Affiliation(s)
- Evangelia Mareti
- 2nd Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Anastasia Vatopoulou
- 3rd Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgia-Alexandra Spyropoulou
- Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Anastasios Papanastasiou
- 2nd Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgios Chrysostomos Pratilas
- 2nd Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Anastasios Liberis
- 2nd Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanouil Hatzipantelis
- Paediatric Haematology Oncology Unit, 2nd Paediatric Department of Aristotle University of Thessaloniki, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Applebaum A, Nessim A, Cho W. Understanding breast asymmetry and its relation to AIS. Spine Deform 2020; 8:381-386. [PMID: 32065382 DOI: 10.1007/s43390-020-00056-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Literature Review. OBJECTIVE Review the pathophysiology, causes, and treatment of breast asymmetry in patients with adolescent idiopathic scoliosis (AIS), as well as postoperative patient assessment and health-related quality of life. BACKGROUND DATA Female breast development begins at 35-day gestation and continues 2-4-year post-thelarche to achieve final volume and shape. During the post-pubertal period, errors in growth and development may result in breast asymmetry. Breast asymmetry typically attenuates with time, but can be pronounced in individuals with AIS. During adolescence, there is rapid development and, thus AIS patients are increasingly sensitive, physically and emotionally, to breast changes. While breast asymmetry can be monitored through radiographic measures and surface topography, pre- and postoperative patient assessment is also critical in determination of optimal patient treatment. METHODS A comprehensive literature review was performed on the pathophysiology, causes, and treatment of breast asymmetry. The advantages and limitations of various treatment options based on patient satisfaction were also investigated. RESULTS Various treatment options exist for breast asymmetry correction in AIS patients. Surgical correction involves an aesthetic outcome, as well as social, physical, and psychological impact on the patient. Despite the benefit of correction surgery, in terms of function and self-image, patient-reported outcomes still appear lower postoperatively in the domains of pain and mental health. CONCLUSION Breast asymmetry is very common, especially among AIS patients, and is often corrected with surgical augmentation. AIS correction surgery has been shown to aggravate breast asymmetry and negatively affect patient-reported outcomes. Other treatment modalities should thus be considered when presented with an adolescent patient. Understanding patient concerns and their relation to quality of life will help guide surgical and medical interventions in correction of AIS deformities. Long-term follow-up studies are necessary to determine whether such interventions are successful and if patients remain healthy. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Ariella Applebaum
- Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA.
| | - Adam Nessim
- Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
| | - Woojin Cho
- Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
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Tsai MJ, Huang WC, Wang JT, Wang MY, Lee YH, Lin SW, Pan SC, Chang SC. Factors associated with treatment duration and recurrence rate of complicated mastitis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:875-881. [PMID: 32327329 DOI: 10.1016/j.jmii.2020.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence of mastitis has increased, and this disease can lead to long antibiotic courses and complications. Here, we aimed to identify the factors associated with antibiotic duration and recurrence of complicated mastitis. MATERIALS AND METHODS This retrospective cohort study was conducted in a tertiary hospital in Taiwan. All hospitalized patients diagnosed with mastitis (ICD-9 code 611.0) from Jan. 1, 2012, to Dec. 31, 2016, were enrolled. Patient characteristics and clinical data were obtained from the medical charts. Recurrence was defined as mastitis within the first year after the discontinuation of antibiotics for at least 7 days. RESULTS In total, 214 females with a median age of 37 years old (IQR 33-45) were enrolled. A total of 148 patients (69.2%) underwent debridement, and 122 (57.0%) underwent biopsy. Histopathological examinations revealed granulation tissue in 44.6% (62/139) of the patients. Positive cultures were obtained in 65.9% (141/214) of the patients. Coagulase-negative staphylococci (64/141, 45.4%) was the most common pathogen, followed by Corynebacterium species (42/141, 29.8%). The median hospitalization length and antibiotic course were 7 (IQR 4-13) and 37 days (IQR 22-77), respectively. Three patients died of breast cancer during treatment. The recurrence rate was 18.5% (39/211). Younger age, corynebacterial infection, and pregnancy were associated with longer treatment durations (P < 0.001, 0.003, <0.001). Corynebacterial infection was associated with a 2.16-fold (95% CI: 1.11-4.20) increase in recurrence after adjusting for age. CONCLUSION Corynebacterial infection is associated with longer treatment courses and an increased recurrence rate of complicated mastitis. Therefore, specific treatments should be considered.
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Affiliation(s)
- Ming-Jui Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chia Huang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Wen Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
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Karaayvaz S. Clinical Evaluation of Breast in Childhood. Eur J Breast Health 2019; 15:137-140. [PMID: 31312787 DOI: 10.5152/ejbh.2019.4745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
Childhood breast masses are mostly benign conditions starting from the newborn period continuing on to adolescence yet can cause high anxiety in the child and the family as well. As a complaint or physical finding, usually palpable mass, pain or discharge from the nipple is apparent in patients. All the clinicians interested in pediatric field should have full knowledge of immature and developing breasts so to proper diagnose and avoid overtreatment with unnecessary diagnostic or surgical procedures. Though malignancy or life-threatening disease has a very low probability during childhood, all child patients should be evaluated and followed up carefully. Especially training and then encouraging young people to periodically start self-assessment of the breasts after their 19th birthday while warning the ones who have had therapeutic chest radiation previously to begin self-assessment 8 years after the procedure or at 25 years of age whichever comes last, will be an appropriate intervention.
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Affiliation(s)
- Selda Karaayvaz
- Division of Social Pediatrics, Department of Pediatrics, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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20
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Postpartum Galactostasis of the Vulva in a Case of Bilateral Lactating Ectopic Breast Tissue. Obstet Gynecol 2019; 134:138-140. [PMID: 31188316 DOI: 10.1097/aog.0000000000003313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the general population, the incidence of accessory breast tissue, a congenital malformation, is 1-5%. The most common site is the lower axilla. Detecting such tissue may be problematic, and accessory breasts below the umbilicus are extremely rare. CASE This report describes the case of a 5-day postpartum 29-year-old woman, G2P2, with painful vulvar swelling 6 cm in diameter. The patient was diagnosed with polymastia in the vulva, without polythelia, with galactostasis due to suturing of a birth laceration covering an excretory duct. The sutures were removed, and the pain decreased. Breastfeeding was continued. CONCLUSION Ectopic breast tissue is rare but should be taken into consideration in the differential diagnosis of a vulvar mass, especially postpartum in lactating women.
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Bhayana A, Misra RN, Bajaj SK, Bankhar H. Clinicoradiologicial aspects of secretory carcinoma breast: A rare pediatric breast malignancy. Indian J Radiol Imaging 2019; 28:448-451. [PMID: 30662208 PMCID: PMC6319105 DOI: 10.4103/ijri.ijri_46_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group. We report imaging and clinicopathological features of secretory carcinoma breast with distant and axillary metastasis, in an 11-year-old girl, who presented with a painful lump in right breast. Ultrasound revealed a well-defined, partially microlobulated hypoechoic mass with skin and pectoralis muscle involvement and a suspicious morphology right axillary lymph node. Color Doppler revealed increased vascularity in both the breast mass and suspicious axillary node. Magnetic resonance imaging helped in better evaluation of pectoralis muscle involvement. Computed tomography (CT) neck, chest, and abdomen revealed multiple fibronodular opacities in bilateral lung fields. 18 Flouro-Deoxy-Glucose Positron Emission Tomography (FDG PET-CT) showed a hypermetabolic retroareolar breast mass with multiple hypermetabolic bilateral lung nodules suggesting lung metastasis. The histopathology confirmed the diagnosis of secretory carcinoma. The patient was offered chemotherapy for 2 years and put on follow-up since then.
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Affiliation(s)
- Aanchal Bhayana
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ritu N Misra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil K Bajaj
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Himani Bankhar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Javed A, Jenkins SM, Labow B, Boughey JC, Lemaine V, Neal L, Shah SS, Pruthi S. Intermediate and long‐term outcomes of fibroadenoma excision in adolescent and young adult patients. Breast J 2019; 25:91-95. [DOI: 10.1111/tbj.13159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Asma Javed
- Division of Pediatric and Adolescent Gynecology Mayo Clinic Rochester Minnesota
| | - Sarah M. Jenkins
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | - Brian Labow
- Department of Plastic and Oral Surgery Boston Children’s Hospital Boston Massachusetts
| | | | | | - Lonzetta Neal
- Division of General Internal Medicine Mayo Clinic Rochester Minnesota
| | - Sejal S. Shah
- Division of Anatomic Pathology Mayo Clinic Rochester Minnesota
| | - Sandhya Pruthi
- Division of General Internal Medicine Mayo Clinic Rochester Minnesota
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McLaughlin CM, Gonzalez-Hernandez J, Bennett M, Piper HG. Pediatric breast masses: an argument for observation. J Surg Res 2018; 228:247-252. [DOI: 10.1016/j.jss.2018.03.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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Abstract
RATIONALE Most breast masses are benign and are rare in adolescent girls. The most frequent tumor is fibroadenoma. Juvenile fibroadenoma is a rare variant of fibroadenoma and is characterized by rapidly enlarging, painless, and unilateral masses occurring at ages between 10 and 18 years. PATIENT CONCERNS A 17-year-old girl who first presented to a hospital due to a left breast tumor. DIAGNOSES Juvenile fibroadenoma of the left breast. INTERVENTIONS She underwent fibroadenoma excision, but she complained of a mass that presented in her left breast 3 months after surgery. After 2 years of observation, the mass became tender and enlarged. We conducted a wide excision of the tumor. Recurrent juvenile fibroadenoma with hypercellular fibromyxoid stroma of the breast was noted. OUTCOMES The patient is in good general condition without tumor relapses during the 4 months of follow-up. LESSONS Recurrent fibroadenomas, particularly those of a large size with a rapid growth rate, in the same breast suggest a high possibility of transformation. We recommend wide tumor resection.
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Affiliation(s)
| | - Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University
| | - Dah-Ching Ding
- School of Medicine, Tzu Chi University, Hualien
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, Republic of China
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Abstract
INTRODUCTION The American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) was developed to guide imaging-based surgical treatment in patients with breast cancer. Studies confirming the BI-RADS did not include adolescents. To evaluate the validity of this classification system in adolescents, we aim to investigate the relationship between the BI-RADS and pathology findings in adolescents. METHODS The medical data of 67 female adolescent patients, aged 12 to 18, referred to our clinic for breast-related complaints between 2013 and 2016 were reviewed retrospectively for demographic data and the results of radiologic and surgical pathologies. RESULTS The main underlying reasons for the visit at the clinic were fullness, tenderness, pain, and palpable masses. Of the 67 patients, 46 were enrolled in the study. After breast ultrasonography, patients whose complaints had diminished were subtracted from the follow-up. The mean age of the patients was 16 years (12 to 18 y). The mean mass diameter size was 3.69 cm (0.9 to 15 cm), and the mean clinical follow-up was 65.3 days (11 to 1095 d). All the patients who were surgically intervened had benign pathology. Of the 21 surgically intervened patients with BI-RADS levels of ≥3, most had fibroadenomas. CONCLUSIONS The BI-RADS classification-based treatment algorithm may not be valid in adolescents. In the present study, all patients with lesions with BI-RADS ≥3 levels had revealed benign pathologies. The BI-RADS classification may show an increased risk. However, to determine the need for a biopsy in adolescents, there is a need for larger-scale pediatric and adolescent studies using the BI-RADS classification.
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De Silva NK. Breast development and disorders in the adolescent female. Best Pract Res Clin Obstet Gynaecol 2018; 48:40-50. [DOI: 10.1016/j.bpobgyn.2017.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022]
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Abstract
RATIONALE Primary rhabdomyosarcoma of the breast is very rare disease with poor prognosis and no definitive treatment has yet been established. PATIENT CONCERNS A 17-year-old girl presented with right breast mass without distant metastasis in image study. DIAGNOSIS The result of core needle biopsy was intraductal carcinoma; however, histopathologic finding after mastectomy was primary rhabdomyosarcoma of breast. INTERVENTIONS Adjuvant chemotherapy was recommended because resection margin was involved by tumor cells, but she did not visit the clinic anymore. Five months later, tumor recurred with local invasion and chemotherapy of vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide (VAC/IE) was done. OUTCOMES In the course of chemotherapy and sequential follow-up, there was no tumor growth until now. LESSONS Primary breast rhabdomyosarcoma is an uncommon disease, as a result diagnosis is often delayed. For the same reason, there is little information about treatment. This report may be helpful for managing the disease.
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Affiliation(s)
- Do Young Kim
- Department of Hematology-Oncology Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
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Abstract
Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.
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A Nonsurgical Approach to Adolescent Breast Asymmetry Using External Prostheses. J Adolesc Health 2017; 61:240-245. [PMID: 28455130 DOI: 10.1016/j.jadohealth.2017.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Currently, there are few nonsurgical treatment options for pediatric patients with developmental breast asymmetry. Our group established a partnership with a prosthetic unit within a local oncology center to provide custom-fit breast prostheses for young women with breast asymmetry. The purpose of this study was to describe the effect of this experience on patients' self-esteem and body image. METHODS Patients were administered an anonymous satisfaction survey at least 1 month after their first fitting at the prosthetic unit. The survey was designed to evaluate body image, self-esteem, as well as social and emotional well-being before and after treatment. Thematic analysis was used to assess their experiences. RESULTS Seventeen patients, aged 12-19 years, visited the prosthetic unit and subsequently completed the retrospective survey. After using the breast prostheses, 14 (82.4%) patients reported an improvement in body image and 12 (70.6%) patients reported an improvement in self-esteem. Benefits pertaining to three emergent themes were revealed: "body wholeness/symmetry," "body image and psychological well-being," and "esthetic outcome." CONCLUSIONS Results from the survey demonstrate the ease and efficacy of a form of nonsurgical treatment for adolescent breast asymmetry. Our partnership with an adult oncology center can serve as a national model to support the development of similar treatment programs. Existing resources that have been previously used only for adult breast cancer survivors can be effectively applied to the adolescent population to ameliorate the negative psychological effects of breast asymmetry.
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Tsilimigras DI, Ntanasis-Stathopoulos I, Bakopoulos A, Schizas D, Kalfa M, Karyda I, Papaioannou D, Klapsinou E, Salla C, Sergentanis TN, Moschovi M. Intraductal papilloma of the breast in an 11-year-old male patient: a case report. Pediatr Surg Int 2017; 33:727-730. [PMID: 28353086 DOI: 10.1007/s00383-017-4081-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/28/2022]
Abstract
Intraductal papilloma (IP) constitutes a rare benign neoplasm among male population with only few reports on childhood patients. Herein, we describe an 11-year-old IP male patient who presented with spontaneous nipple discharge of his right breast.
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Affiliation(s)
| | | | - Anargyros Bakopoulos
- Third Department of Surgery, Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kalfa
- Department of Cytopathology, Hygeia Hospital, Athens, Greece
| | | | | | | | - Charitini Salla
- Department of Cytopathology, Hygeia Hospital, Athens, Greece
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str., Athens, 115 27, Greece.
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, "Aghia Sofia" Children's Hospital, Athens, Greece
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Singh SK, Gupta P, Arora R, Singla S, Mishra B, Singh K. Giant fibroadenoma with massive infarction masquerading as malignancy: a case report. Int Cancer Conf J 2017; 6:167-170. [PMID: 31149495 DOI: 10.1007/s13691-017-0299-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/30/2017] [Indexed: 10/19/2022] Open
Abstract
Fibroadenoma is a common benign breast lesion that usually affects women in their second and third decade of life and usually present as small mobile painless lump. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can undergo infarction leading to significant morbidity and difficulty to distinguish from the more aggressive phyllodes tumors or carcinoma. We report an interesting case of giant fibroadenoma (17 × 11 × 7 cm) with massive infarction during lactation, further complicated by lactational mastitis with close resemblance to cystosarcoma phyllodes. Detailed clinical evaluation and proper investigation in the form of USG breast and PET-CT scan helped us to delineate the nature of pathology. Simple excision of lesion with curvilinear incision was done with excellent cosmetic outcome. Histopathologic features were consistent with fibroadenoma (giant) with large areas of infarction. Fibroadenoma breast has varied clinical presentations. The course of disease may be complicated by pregnancy, lactation and inflammatory processes. Massive infarction may make the picture more dubious and masquerade with malignant transformation altering our treatment decision. The presence of necrosis on core biopsy or intra-operative finding should be cautiously interpreted and is not itself a sign of malignancy. Detailed clinical evaluation and comprehensive workup should be done before embarking on radical treatment.
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Affiliation(s)
| | - Pawan Gupta
- 1Institute of Cancer Care, Jaypee Hospital, Noida, 201304 India
| | - Raman Arora
- 1Institute of Cancer Care, Jaypee Hospital, Noida, 201304 India
| | - Suhas Singla
- 1Institute of Cancer Care, Jaypee Hospital, Noida, 201304 India
| | - Bharat Mishra
- 1Institute of Cancer Care, Jaypee Hospital, Noida, 201304 India
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Broecker JS, Khoshnam N, Thompson L, Anis S, Kamal N, Gillespie S, Kantarovich D, Metry D, Mills MP, Drummey R, Williams B, Shehata BM. Primary Pediatric Breast Lesions: Comparing the Prevalence of Malignancies in the Middle East with North America; Review of 1031 Cases. Fetal Pediatr Pathol 2017; 36:139-148. [PMID: 28426344 DOI: 10.1080/15513815.2017.1290724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Benign breast masses are uncommon but are becoming more recognized among the pediatric population. Malignant breast lesions are very rare. The aim of our study was to review and compare the demographics, clinical presentation, treatment, and outcomes of breast lesions, including primary malignancies, and to discuss theories that may explain why there is an increased rate of breast cancers diagnosed at a younger age in the Egyptian population. A total of 1031 cases were reviewed. Comparisons were made between the Egyptian (n = 846) and US (n = 185) cohorts. There were 30 (3.5%) malignant tumors in the Egyptian group with 17 (2%) deaths versus 3 (1.6%) malignant tumors in the US group with 2 (1%) deaths (p = 0.247). The relative risk of breast cancer in the Egyptian group was 2.16 (95% confidence interval (CI): 0.67-7.01) compared with the US group. The trend for increased risk of breast cancer in Egypt may be due to delayed diagnosis because of decreased awareness.
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Affiliation(s)
| | - Nasim Khoshnam
- a Emory University School of Medicine , Atlanta , Georgia , USA
| | - Laura Thompson
- a Emory University School of Medicine , Atlanta , Georgia , USA
| | - Shady Anis
- b Department of Pathology , Cairo University , Giza , Egypt
| | - Nora Kamal
- b Department of Pathology , Cairo University , Giza , Egypt
| | - Scott Gillespie
- a Emory University School of Medicine , Atlanta , Georgia , USA
| | | | - Diana Metry
- a Emory University School of Medicine , Atlanta , Georgia , USA
| | - Mary Pate Mills
- a Emory University School of Medicine , Atlanta , Georgia , USA
| | - Rachel Drummey
- a Emory University School of Medicine , Atlanta , Georgia , USA
| | | | - Bahig M Shehata
- a Emory University School of Medicine , Atlanta , Georgia , USA.,c Department of Pathology , Children's Healthcare of Atlanta , Atlanta , Georgia , USA
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Ross DS, Giri DD, Akram MM, Catalano JP, Olcese C, Van Zee KJ, Brogi E. Fibroepithelial Lesions in the Breast of Adolescent Females: A Clinicopathological Study of 54 Cases. Breast J 2017; 23:182-192. [PMID: 28299887 PMCID: PMC5356480 DOI: 10.1111/tbj.12706] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fibroepithelial lesions (FELs) are the most frequent breast tumors in adolescent females. The pubertal hormonal surge could impact the growth and microscopic appearance of FELs in this age group. In this study, we evaluate the morphology and clinical behavior of FELs in adolescents. We searched the 1992-2012 pathology data base for FELs in females 18 years old or younger (F ≤18 years). Seven FELs from 1975 to 1983 were also included. Three pathologists reviewed all available material. Patient (pt) characteristics and follow-up information were obtained from electronic medical records. Forty-eight F ≤18 years had 54 FELs with available slides. Thirty (67%) pts were Caucasian, 12 (27%) African-American, two (4%) Hispanic, one (2%) Asian; three were of unknown race/ethnicity. Median age at diagnosis was 16 years. Median age at menarche was 12 years; most (96%) FELs occurred after menarche (median interval 48 months). All patients underwent lumpectomy; one required subsequent mastectomy. The FELs were 34 fibroadenomas (FAs) (11 usual, 23 juvenile), and 20 phyllodes tumors (PTs) (16 benign, one borderline and three malignant). Eight (35%) juvenile FAs showed slight intratumoral heterogeneity. The mean mitotic rate was 1.3 mitoses/10 high-power fields (HPFs) (range, 0-6) in usual FAs, 1.8/10 HPFs in juvenile FAs, 3.1/10 HPFs in benign PTs, 10/10 HPFs in the borderline PT and 17/10 HPFs in malignant PTs. The mean follow-up for 29 pts with 33 FELs was 44 months. Two (10%) PTs recurred locally (a benign PT at 18 months, and a borderline PT at 11 months). Both recurrent PTs had microscopic margins <1 mm. Mitotic activity in FAs from adolescents can be substantial and this finding should be interpreted cautiously. Awareness of the morphologic features of FELs in adolescents is important to avoid overdiagnosis of PTs, which can lead to additional unnecessary and potentially disfiguring surgery.
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Affiliation(s)
- Dara S. Ross
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Dilip D. Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | | | - Cristina Olcese
- Department of Surgery, Memorial Sloan Kettering Cancer Center
| | | | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center
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Kupsik M, Yep B, Sulo S, Memmel H. Giant juvenile fibroadenoma in a 9-year-old: A case presentation and review of the current literature. Breast Dis 2017; 37:95-98. [PMID: 28655118 DOI: 10.3233/bd-160250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5-4% of all cases of fibroadenomas. Giant fibroadenomas are well-circumscribed, firm breast masses characterized by proliferation of epithelial and connective tissue. They are defined as being larger than 5 cm or weighing more than 500 g. The peak age has been reported between the ages of 17 and 20, with less than 5% of these in patients less than 18-years-old.We present a 9-year-old, pre-menstrual, Nigerian female with no known family history of breast masses or cancers who developed spontaneous giant fibroadenoma measuring approximately 13 cm × 13 cm. Rapid growth of a breast mass can be of great concern to such young patients whose breasts are in the early formative stages. It is important to promptly rule out malignant processes or phyllodes tumor, and educate young patients and their families on treatment options that fit their unique concerns and circumstances.
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Affiliation(s)
- Michalina Kupsik
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
| | - Brian Yep
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Suela Sulo
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
| | - Heidi Memmel
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL 60068, USA
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How to approach breast lesions in children and adolescents. Eur J Radiol 2015; 84:1350-64. [DOI: 10.1016/j.ejrad.2015.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 04/10/2015] [Accepted: 04/11/2015] [Indexed: 12/25/2022]
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Michala L, Tsigginou A, Zacharakis D, Dimitrakakis C. Breast disorders in girls and adolescents. Is there a need for a specialized service? J Pediatr Adolesc Gynecol 2015; 28:91-4. [PMID: 25850589 DOI: 10.1016/j.jpag.2014.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/21/2014] [Accepted: 05/31/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Minor breast concerns in childhood and adolescence are common and lead to increased anxiety among young patients and their families, particularly due to high correlation with breast cancer. However, most breast services aim at managing adults and triaging patients with breast cancer, whereas adolescent medicine specialists or pediatricians are usually not appropriately trained to identify and treat breast pathology. METHODS We reviewed hospital records of all patients attending a pediatric and adolescent gynecology or breast clinic of a tertiary referral hospital, with a breast related symptom, between January 2009 and December 2011. We collected information regarding age at presentation, age at menarche, diagnosis, management and outcome. RESULTS We identified 81 patients of which 11 presented with an abnormal nipple or areolar secretion, 33 had a palpable lump, 20 had mastitis, and 16 had unequal breast development. One patient presented with virginal breast hypertrophy. Three out of 11 of the patients with an abnormal secretion had a cyst identified on ultrasonography. Out of the palpable lumps 12 were fibroadenomas, 3 were phyllodes tumors, and 14 were cystic in nature. The phyllodes tumors and half of the fibroadenomas were removed. The remaining fibroadenomas remain under regular ultrasonographic follow-up. All cases of mastitis were treated conservatively and resolved with broad spectrum antibiotic treatment. CONCLUSION In our series, no malignancies were identified. Although 8 patients required surgical treatment, the majority of cases were treated conservatively.
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Affiliation(s)
- Lina Michala
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece.
| | - Alexandra Tsigginou
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - Dimitris Zacharakis
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece
| | - Constantine Dimitrakakis
- 1(st)Department of Obstetrics and Gynaecology, University of Athens, Alexandra Hospital, Athens, Greece
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Conde DM. Treatment approach for breast abscess in nonlactating adolescents. Int J Gynaecol Obstet 2014; 128:72-3. [DOI: 10.1016/j.ijgo.2014.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/07/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
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Crerand CE, Magee L. Cosmetic and reconstructive breast surgery in adolescents: psychological, ethical, and legal considerations. Semin Plast Surg 2014; 27:72-8. [PMID: 24872744 DOI: 10.1055/s-0033-1343999] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cosmetic and reconstructive breast surgery has increased in popularity among adolescents in the United States. As more adolescents pursue these procedures, an understanding of the psychological aspects of these surgeries becomes increasingly important for the benefit of both patients and providers. The authors review the psychological aspects of cosmetic and reconstructive surgical breast procedures as they pertain to adolescents, including augmentation mammoplasty, gynecomastia correction, breast reduction, and asymmetry correction. They include a discussion of the medicolegal and ethical implications of these procedures and recommendations for clinical management.
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Affiliation(s)
- Canice E Crerand
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania ; Division of Plastic Surgery, Department of Surgery, The Edwin and Fannie Gray Hall Center for Human Appearance, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
Hypoplastic breast anomalies remain a reconstructive challenge. In this article, the authors review the spectrum of nonsyndromic breast hypoplasia in the adolescent girl, namely idiopathic breast hypoplasia and tuberous breast deformity. Challenges specific to this population include (1) identifying the ideal timing for surgery, (2) choosing the optimal reconstructive method while taking into consideration ongoing changes in the female body (e.g., future pregnancy), and (3) considering the use of a two-stage reconstructive approach to gradually expand the skin envelope. A comprehensive review of surgical techniques that address these conditions is provided, taking into account the evolution and the most recent advances in surgical techniques.
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Affiliation(s)
- Sebastian Winocour
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Valerie Lemaine
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
The mainstay of breast imaging in the adolescent is ultrasonography. There is occasionally a need for additional imaging, particularly with magnetic resonance imaging (MRI). Imaging of the adolescent breast differs substantially from the adult in both the imaging modalities utilized and the relative likelihood of pathologies encountered. The majority of lesions in the adolescent are benign, but the presence of a breast lesion may cause anxiety to patients and their families due to the wide awareness of breast malignancy in the adult population. It is important to be aware of the imaging modalities available to image the adolescent breast to prevent unnecessary radiation exposure while answering the clinical question. The current recommendations for adolescent diagnostic and screening breast imaging will be reviewed. Benign breast lesions such as fibroadenomas, fibrocystic change, pseudoangiomatous stromal hyperplasia, gynecomastia, and posttraumatic or infectious lesions with their associated imaging findings and management will be outlined. Additionally, review of breast malignancies that can affect adolescents will provide the reader with features to distinguish benign from malignant processes in the adolescent based on imaging findings and clinical presentation.
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Affiliation(s)
- Katie N Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Borsook J, Thorner PS, Grant R, Langer JC. Juvenile fibroadenoma arising in ectopic breast tissue presenting as an axillary mass. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Arowolo OA, Akinkuolie AA, Adisa AO, Obonna GC, Olasode BJ. Giant fibroadenoma presenting like fungating breast cancer in a Nigerian teenager. Afr Health Sci 2013; 13:162-5. [PMID: 23658584 PMCID: PMC3645107 DOI: 10.4314/ahs.v13i1.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Giant fibroadenoma of the breast is a rare benign breast tumour which seldom grows to a giant size, it is even rarer for this benign tumour to grow rapidly, ulcerate spontaneously and present like a fungating breast tumour in a way mimicking breast cancer. CASE PRESENTATION This is a presentation of a 14 year old premenarchal girl with a massive ulcerating and fungating left breast mass that was initially thought to be a fungating locally advanced breast carcinoma on clinical examination. Further examination of the morphology of the resected surgical specimen and histological examination confirmed it to be giant fibroadenoma of the breast. It was successfully managed by partial mastectomy and breast reconstruction with an excellent result and a high degree of patient satisfaction was achieved. CONCLUSION Though a rare clinical entity benign breast tumour can present like a fungating breast cancer and this must be bore in mind especially in young adolescent patients presenting with ulcerating breast tumour.
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Affiliation(s)
- O A Arowolo
- Department of Surgery, Obafemi Awolowo University Ile Ife, Osun State, Obafemi Nigeria.
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Our surgical approach to treatment of congenital, developmental, and acquired breast asymmetries: a review of 30 cases. Aesthetic Plast Surg 2013; 37:77-87. [PMID: 23307108 DOI: 10.1007/s00266-012-0041-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Peer pressure and the modern definition of beauty have led people to strive for breast perfection. The aim of our study was to emphasize the importance and frequency of nonmastectomy-related breast asymmetry and explain our approach to such patients using a combination of techniques. METHODS We retrospectively reviewed 30 patients with nonmastectomy breast asymmetry (i.e., patients with Poland's syndrome, tumors, burns, and tuberous breasts) admitted to our clinic between 2001 and 2011. Patients were followed up for a mean of 25 months postoperatively (range 4-72 months). These patients completed a satisfaction questionnaire regarding scarring, size, symmetry, shape, and nipple-areola complex sensation. RESULTS Patient distribution and preferred treatment method according to etiology were screened. For mild Poland's syndrome, breast implants with symmetrization procedures (when needed) were used. In two patients, however, fat grafting was sufficient to correct the deformity. For severe Poland's syndrome, a tissue expander was first placed and wrapped by regional local flaps, such as the pedicled latissimus dorsi muscle flap, accompanied by fat grafting for infraclavicular depression and an absent anterior axillary fold. After adequate expansion of the skin and muscle flap, a silicone prosthesis replaced the tissue expanders. CONCLUSIONS Tissue expanders with or without muscle flaps along with fat grafting in multiple sessions are necessary steps in the treatment of breast asymmetry. Knowledge and application of multiple techniques in a step-by-step fashion helps the surgeon to achieve optimal functional and aesthetic results for each patient. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Cheng PJ, Vu LT, Cass DL, Hicks MJ, Brandt ML, Kim ES. Endoscopic specimen pouch technique for removal of giant fibroadenomas of the breast. J Pediatr Surg 2012; 47:803-7. [PMID: 22498401 DOI: 10.1016/j.jpedsurg.2012.01.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/11/2012] [Accepted: 01/25/2012] [Indexed: 11/18/2022]
Abstract
Giant (juvenile or cellular) fibroadenoma of the breast is the most common tumor that present in adolescent girls. As benign tumors that can exceed 10 cm in diameter, giant fibroadenomas have historically necessitated large incisions to remove these masses, resulting in large unsightly scars. We describe the novel use of an endoscopic specimen pouch to facilitate the removal of these large tumors through minimal incisions in 3 patients. In follow-up, all 3 patients have had excellent cosmetic outcomes, no recurrences, and no postoperative complications.
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Affiliation(s)
- Philip J Cheng
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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46
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Kulkarni D, Dixon JM. Congenital abnormalities of the breast. WOMENS HEALTH 2011; 8:75-86; quiz 87-8. [PMID: 22171777 DOI: 10.2217/whe.11.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Congenital abnormalities of the breast and chest wall are seen frequently in breast, pediatric and plastic surgery clinics. Management involves a multidisciplinary team approach. The treatment for many of these conditions includes surgical correction. If the child is still growing, treatment timing is crucial and many of the surgical corrective procedures require more than one operation over a number of years. Although these deformities have less impact on functional capacity, the psychological consequences can be serious in adolescent patients. They can experience embarrassment, social isolation and complexities during sexual development, and this results in problems with relationships. The aim of this article is to spread awareness among the medical community of this range of conditions, so appropriate referrals are made and their impact is reduced by timely appropriate surgical intervention if appropriate.
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Affiliation(s)
- Dhananjay Kulkarni
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, UK.
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Durkin ET, Warner TF, Nichol PF. Enlarging unilateral breast mass in an adolescent male: an unusual presentation of intraductal papilloma. J Pediatr Surg 2011; 46:e33-5. [PMID: 21616226 DOI: 10.1016/j.jpedsurg.2011.02.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/22/2011] [Accepted: 02/25/2011] [Indexed: 11/17/2022]
Abstract
Breast masses presenting in adolescent boys are rare and are almost uniformly owing to gynecomastia. Although surgical referral for breast masses in adolescent boys is common, intervention is typically for cosmesis. We report the case of a 14-year-old boy who presented with an enlarging unilateral breast mass, which was found to be owing to an intraductal papilloma at the time of surgical excision.
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Affiliation(s)
- Emily T Durkin
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Pathologie mammaire de l’adolescente. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Koltz PF, Sbitany H, Myers RP, Shaw RB, Patel N, Girotto JA. Reduction mammaplasty in the adolescent female: The URMC experience. Int J Surg 2011; 9:229-32. [DOI: 10.1016/j.ijsu.2010.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/18/2010] [Accepted: 12/03/2010] [Indexed: 11/26/2022]
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