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Millan-Arreola E, Lozano-Jaramillo DA, Tello De Meneses-Salazar A, Esquer-Cota OO, Lavara-Miranda LA, Valenzuela-Espinoza MA. Borderline Phyllodes Tumor in a Child. World J Oncol 2023; 14:584-588. [PMID: 38022409 PMCID: PMC10681785 DOI: 10.14740/wjon1716] [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: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Phyllodes tumor (PT) is considered a rare fibroepithelial tumor. Very few series have been reported in children and adolescents. Based on histopathological features, it can be classified as benign, borderline, or malignant, with the latter having a more aggressive clinical behavior. We report the case of a 10-year-old female who began with an asymptomatic mobile right breast mass. An initial fine needle biopsy (FNB) concluded fibroadenoma (FA). Months later, the mass kept growing, with the appearance of pain and nipple discharge. Benign PT was demonstrated in a new biopsy. A total mastectomy was performed. The post-surgical histopathological examination was compatible with a borderline PT. The patient is now symptom-free and with no signs of relapse. Not all breast masses in the pediatric or adolescent age bracket are FA. Attention is warranted when the clinical behavior does not follow the usual outline. PT has to be considered as a possible diagnosis and treated accordingly.
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Affiliation(s)
| | - Diego Alberto Lozano-Jaramillo
- Centro Oncologico Pediatrico de Baja California, Tijuana, Mexico
- Centro de Investigacion Valle Bibb Fundacion, Tijuana, Mexico
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Ostertag-Hill CA, Wang Y, Nickolich S, Wiggins DL. Bloody nipple discharge due to intraductal papilloma in an adolescent girl. BMJ Case Rep 2023; 16:e254177. [PMID: 36878614 PMCID: PMC9990612 DOI: 10.1136/bcr-2022-254177] [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: 03/08/2023] Open
Abstract
An early adolescent girl was referred to our breast surgery clinic with multiple right-sided breast masses and several months of unilateral bloody nipple discharge. MRI demonstrated multiple enhancing masses in the right breast with intrinsic hypertensive T1 signal of the ducts extending to the nipple. A biopsy showed partially sclerosed intraductal papillomas without atypia or malignancy. Following extensive counselling with the patient and her family, two palpable breast masses and a single central breast duct responsible for bloody nipple discharge were fully excised. Histopathological analysis showed unique overlapping features of resembling intraductal papilloma, nipple adenoma and fibroadenomas. The patient has had resolution of her bloody nipple discharge and excellent cosmetic outcomes post-surgery. Intraductal papilloma is rare in the adolescent population and the risk of concurrent and future malignancy is not well established. Thus, a tailored approach to the work-up and management of paediatric breast masses is essential.
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Affiliation(s)
- Claire Alexandra Ostertag-Hill
- Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Stana Nickolich
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Doreen L Wiggins
- Department of Surgery, Rhode Island Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Knaus ME, Onwuka AJ, Bowder A, Courtney C, Deans KJ, Downard CD, Duran YK, Fallat ME, Fraser JD, Gadepalli SK, Kabre R, Kalbfell EL, Kohler J, Lal DR, Landman MP, Lawrence AE, Leys CM, Lu P, Mak GZ, Markel TA, Merchant N, Nguyen T, Pilkington M, Port E, Rymeski B, Saito J, Sato TT, St Peter SD, Wright T, Minneci PC, Grabowski JE. Disparities in the Management of Pediatric Breast Masses. J Surg Res 2022; 279:648-656. [PMID: 35932719 DOI: 10.1016/j.jss.2022.06.049] [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: 03/11/2022] [Revised: 05/18/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Disparities in surgical management have been documented across a range of disease processes. The objective of this study was to investigate sociodemographic disparities in young females undergoing excision of a breast mass. METHODS A retrospective study of females aged 10-21 y who underwent surgery for a breast lesion across eleven pediatric hospitals from 2011 to 2016 was performed. Differences in patient characteristics, workup, management, and pathology by race/ethnicity, insurance status, median neighborhood income, and urbanicity were evaluated with bivariate and multivariable regression analyses. RESULTS A total of 454 females were included, with a median age of 16 y interquartile range (IQR: 3). 44% of patients were nonHispanic (NH) Black, 40% were NH White, and 7% were Hispanic. 50% of patients had private insurance, 39% had public insurance, and 9% had other/unknown insurance status. Median neighborhood income was $49,974, and 88% of patients resided in a metropolitan area. NH Whites have 4.5 times the odds of undergoing preoperative fine needle aspiration or core needle biopsy compared to NH Blacks (CI: 2.0, 10.0). No differences in time to surgery from the initial imaging study, size of the lesion, or pathology were observed on multivariable analysis. CONCLUSIONS We found no significant differences by race/ethnicity, insurance status, household income, or urbanicity in the time to surgery after the initial imaging study. The only significant disparity noted on multivariable analysis was NH White patients were more likely to undergo preoperative biopsy than were NH Black patients; however, the utility of biopsy in pediatric breast masses is not well established.
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Affiliation(s)
- Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Amanda J Onwuka
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | | | | | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | | | | | | | | | | | | | | | | | - Dave R Lal
- Children's Wisconsin, Milwaukee, Wisconsin
| | | | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Patricia Lu
- St. Louis Children's Hospital, St. Louis, Missouri
| | - Grace Z Mak
- Comer Children's Hospital, Chicago, Illinois
| | | | - Naila Merchant
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tina Nguyen
- C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | | | - Elissa Port
- Lurie Children's Hospital, Chicago, Illinois
| | - Beth Rymeski
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
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