Breast disorders in children and adolescents

Giant Juvenile Fibroadenoma: Case Report and Review of the Literature

Fibroadenomas are common benign breast tumors. Fibroadenomas that exceed 5 cm in diameter, weigh more than 500 g, or replace more than four-fifths of the breast are characterized as giant. A fibroadenoma diagnosed in patients during childhood or adolescence is characterized as juvenile. An extensive PubMed search of the literature in English up until August 2022 was performed. In addition, a rare case of a gigantic fibroadenoma in an 11-year-old premenarchal girl who was referred to our adolescent gynecology center is presented here. Eighty-seven cases of giant juvenile fibroadenomas have been reported in the literature along with our case. Patients with giant juvenile fibroadenoma presented at a mean age of 13.92 years and usually after menarche. Juvenile fibroadenomas are usually unilateral, occurring either in the right or the left breast; the majority of them are diagnosed when they are already more than 10 cm in size, and they are most frequently treated with total lump excision. Differential diagnosis includes phyllodes tumors and pseudo-angiomatous stromal hyperplasia. Conservative management is feasible, but surgical excision is recommended to patients with suspicious imaging features or when the mass grows rapidly.

The evolution of perennially enlarged breasts in women: a critical review and a novel hypothesis

The possession of permanent, adipose breasts in women is a uniquely human trait that develops during puberty, well in advance of the first pregnancy. The adaptive role and developmental pattern of this breast morphology, unusual among primates, remains an unresolved conundrum. The evolutionary origins of this trait have been the focus of many hypotheses, which variously suggest that breasts are a product of sexual selection or of natural selection due to their putative role in assisting in nursing or as a thermoregulatory organ. Alternative hypotheses assume that permanent breasts are a by-product of other evolutionary changes. We review and evaluate these hypotheses in the light of recent literature on breast morphology, physiology, phylogeny, ontogeny, sex differences, and genetics in order to highlight their strengths and flaws and to propose a coherent perspective and a new hypothesis on the evolutionary origins of perennially enlarged breasts in women. We propose that breasts appeared as early as Homo ergaster, originally as a by-product of other coincident evolutionary processes of adaptive significance. These included an increase in subcutaneous fat tissue (SFT) in response to the demands of thermoregulatory and energy storage, and of the ontogenetic development of the evolving brain. An increase in SFT triggered an increase in oestradiol levels (E2). An increase in meat in the diet of early Homo allowed for further hormonal changes, such as greater dehydroepiandrosterone (DHEA/S) synthesis, which were crucial for brain evolution. DHEA/S is also easily converted to E2 in E2-sensitive body parts, such as breasts and gluteofemoral regions, causing fat accumulation in these regions, enabling the evolution of perennially enlarged breasts. Furthermore, it is also plausible that after enlarged breasts appeared, they were co-opted for other functions, such as attracting mates and indicating biological condition. Finally, we argue that the multifold adaptive benefits of SFT increase and hormonal changes outweighed the possible costs of perennially enlarged breasts, enabling their further development.

Breast Asymmetry, Classification, and Algorithm of Treatment: Our Experience

BACKGROUND

In the literature, several classifications of breast asymmetries and treatment protocols have been proposed over time, which are mainly based on etiological or morphological characteristics of the deformity. The aim of this study was to present our new classification, based on patient's self-consciousness of breast asymmetry, a simple and reliable treatment algorithm is also presented.

METHODS

The case series included 343 patients treated between January 2006 and January 2015. Only patients presenting with developmental breast asymmetries were included in the study. All patients underwent prior classification in three groups based on the patient's degree of awareness of their asymmetry. A specific treatment algorithm was associated with each group according to breast size, grade of ptosis, and patient's desire. At the 48-month follow-up appointment, patients completed an anonymous questionnaire that addressed satisfaction with breast shape, size, and symmetry, scar appearance, body perception, self-esteem, perceived attractiveness, intimate life, and overall feelings about their breasts.

RESULTS

Mean patient age was 24.6 years (range 18-57 years). Mean follow-up was 54.4 months (6 months to 9 years). At the 48-month follow-up, 66.7% of the patients completed a visual analog scale (VAS) satisfaction questionnaire. An overall satisfaction rate of 77.0% was reported, and a statistically significant difference in the distribution of the overall satisfaction between groups was found. No patient expressed complete dissatisfaction.

CONCLUSIONS

The proposed classification and the surgical algorithm is a simple, applicable, and reliable method to assess and treat breast asymmetries with a high satisfaction rate as confirmed from our results.

LEVEL OF EVIDENCE IV

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Juvenile Fibroadenoma at Menarche: A Case Series

Juvenile fibroadenomas of the breast are benign neoplasms. They present during the development phase of the breast. They are poorly understood because of their rarity and unpredictable behavior. In this article, a series of three different sonographic breast cases are provided of adolescent girls, who were brought for medical evaluation of a large breast lump, which had presented just after menarche. The results of evaluating these cases revealed that sonography of the breast was helpful in characterizing and delineating the extent of the lump. In conclusion, giant fibroadenomas of the breast, at menarche, are also known as juvenile fibroadenomas. They are a dilemma for the clinician, radiologist, and pathologist alike. The use of ultrasound can assist with characterizing these lesions, as an incorrect diagnosis could lead to a disfiguring surgery, for a young girl.

Giant juvenile fibroadenoma in a 9-year-old: A case presentation and review of the current literature

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.

Inframammarial Giant Fibroadenoma Removing and a Nipple-sparing Breast Reconstruction in an Adolescent: A Case Report

Fibroadenomas are common, benign breast tumors that usually affect women in the second and third decade of life. Giant fibroadenomas often cause significant concern for the patient or family regarding malignant potential and altered breast development. Most fibroadenomas are benign. Local excision of small lesions through a circumareolar or inframammary incision rather than radical surgery is appropriate. Breast ultrasound represents the most commonly used imaging modality for the study of pediatric female breast masses and fibroadenomas. Detailed descriptions of the sonographic appearances of fibroadenomas in young girls are sparse. We believe that surgical treatment for the patient should include tumor extirpation and immediate restoration of breast appearance, minimizing visible scars, protection of the developing breast bud, nipple, and areola. This modality reduces psychosocial comorbidity.

Giant fibroadenoma growing rapidly during pregnancy

Introduction:

Giant fibroadenoma is a rare disease with unknown etiology. During pregnancy, fibroadenomas increase in size and may show lactational histologic changes. High concentrations of estrogen, progesterone, and prolactin promote the ductal growth and formation of tubuloalveolar structures. This may be a reason for the significant enlargement in this period.

Case Presentation:

We presented a case of giant fibroadenoma, first detected at the onset of pregnancy, which grew rapidly and was excised surgically two months after the birth. There was no marked deformity in the breast nor a need to reconstruct it, despite the giant mass was excised and the mother was lactating.

Discussion:

We presented a rare case of giant fibroadenoma in a lactating woman. A progressively growing mass in breast can lead to structural damages. The current management approach for giant fibroadenomas is still surgical excision.

Management of pediatric and adolescent breast masses

Breast masses in children and adolescents are uncommon and most often benign. Occasionally, however, they require surgical intervention for lifestyle limiting symptoms or malignant potential. These masses are best evaluated with physical exam and ultrasound. Breast masses likely to be encountered by the surgeon in the pediatric and adolescent population include intraductal papillomas, phyllodes tumors, primary breast cancer, and metastatic lesions. Unlike adults, pediatric and adolescent breast cancer tends to be of the secretory variety and typically have less metastatic potential. However, cases of inflammatory and medullary breast cancers have also been reported in girls and appear more aggressive. Radiation exposure during breast development is a risk factor to subsequent development of breast cancer. Surgical objective for a concerning pediatric and adolescent breast mass is complete resection while preserving normal breast development, when appropriate. The need for routine axillary dissection for malignant cases in children appears unnecessary from the limited data available, and the authors favor sentinel lymph node sampling and reserve axillary dissection for positive lymph nodes.

Benefits of immediate dermoglandular preserving reconstruction following giant fibroadenoma excision in two patients

Giant fibroadenoma is a rare, benign stromal tumor that typically occurs in adolescent women. This rapidly-growing tumor can result in a significant aesthetic and psychosocial morbidity due to gross asymmetry changes in the overlying skin envelope and concerns about malignancy. On initial work-up this lesion must be differentiated from other rare primary breast tumors, including phyllodes tumor, or metastatic disease. Appropriate treatment of giant fibroadenoma requires surgical excision; however, many surgeons are reluctant to perform a concomitant mastopexy or reconstruction at the time of tumor extirpation. This conservative approach results in a loose, ptotic, aesthetically displeasing breast postoperatively. While some degree of skin retraction is expected, patients may have to wait for up to a year to see final results, and further surgical correction may still be required. It is unknown whether these surgeons are not familiar with these techniques or hesitate to increase the amount of scarring on the breast mound of a young female. Using an immediate dermoglandular preserving mastopexy after giant fibroadenoma excision, we have decreased postoperative breast ptosis, removed much of the lax, poor-quality skin and achieved stable, long-term results in two patients. This technique improves the immediate aesthetic outcome, reduces the psychosocial comorbidity associated with waiting for skin retraction and decreases the likelihood of a second surgery.

Occurrence of two rare malignant neoplasms (breast and ovarian) in an adolescent female

BACKGROUND

Phyllodes breast tumors, particularly malignant ones, are rare in adolescents. Tumor behavior does not correlate with histopathology. This case of an adolescent with a malignant phyllodes tumor, followed by the occurrence of a borderline ovarian tumor, also uncommon in adolescence, may shed light on our understanding of phyllodes and uncommon gynecologic malignancies in the young.

CASE

A-14 year-old Caucasian female underwent wide local excision of a 4-cm malignant phyllodes breast tumor. At 17 years of age she had excision of a serous borderline tumor of the ovary.

COMMENTS

The occurrence of two rare neoplasms in an adolescent female raises questions about a common underlying etiology, such as a genetic mutation. Genetic evaluation of minors is a sensitive and complex issue. Natural history studies regarding phyllodes tumors presenting in adolescence are needed to establish recommendations regarding best practice, including the role of genetic evaluation in this population.

A phyllodes tumor in a child

Phyllodes tumor of the breast is a rare neoplasm, particularly in adolescent girls and young women. It is usually presented as a unilateral palpable mass. We are reporting the case of an 11-year-old adolescent girl who came to our Diagnostical Imaging Department with non-hematic nipple discharge. Ultrasound, mammography, and magnetic resonance imaging were performed. The histological examination showed a phyllodes tumor. The management and the biological behavior of this uncommon tumor are discussed with particular regard to the very unusual clinical presentation in this patient.

Poland's syndrome: current thoughts in the setting of a controversy

Poland's syndrome is a rare congenital disorder that is characterized by hypoplasia of the pectoralis muscles and ipsilateral webbing of the fingers. The name of this condition pays homage to Dr. Alfred Poland of Guy's Hospital, who in 1841 described a case of these two deformities during the autopsy of a 27-year-old convict. An exploration of the historical series reveals a clear progression of knowledge about this syndrome, accumulated by scientists across Europe and America. As such, the name "Poland's syndrome" stands as a point of contention to those who oppose the injudicious use of eponyms in medicine. An analysis of the relevant literature reveals a stepwise understanding of what has come to be known as Poland's syndrome.

Phyllodes tumor of the breast in an adolescent girl

Phyllodes tumor (PT) is an uncommon tumor in adolescent girls and young women. A case of PT in a 14-year-old girl is reported. The clinical examination showed a painless tumor that had grown during 10 months. Total excision of the mass with wide margin was performed. The diagnosis, behavior, and treatment of this rare tumor are discussed.

Breast Asymmetry: Presentation of a Giant Fibroadenoma

Patients often present to plastic surgeons with breast asymmetry of unknown etiology. Many patients are females in late adolescence and present complaining of a hypoplastic breast on the smaller side. However, full evaluation may reveal that the larger breast contains the abnormality. Fibroadenomas typically present as firm, mobile, painless, easily palpable breast nodules. However, giant fibroadenomas can present as unilateral macromastia without definable borders or texture differences. Diagnosis is essential since fibroadenomas tend to persist and grow. However, physical examination and standard radiographic evaluations (mammograms and ultrasounds) fail to clarify the diagnosis in many cases. Magnetic resonance imaging (MRI) has improved preoperative diagnosis, but tissue diagnosis is frequently necessary and resection of giant fibroadenomas is essential as they enlarge to the point of causing psychological detriment or mass effects, including venous congestion, glandular distortion, pressure necrosis, and occasionally ulceration. In this article we review nine patients presenting with unilateral macromastia to a tertiary breast care center with a review of the pertinent literature. The differential diagnosis, evaluation modalities, and treatment options of breast asymmetry and unilateral breast masses are presented. Postexcision breast reconstruction is discussed.

Breast Disorders in Children and Adolescents

Concerns about problems of the breast are often noted in adolescents and their parents. This review discusses issues and disorders of the breast in children and adolescents, starting with basic principles of embryology and adolescent breast development. Concepts that are covered include congenital breast disorders, abnormal timing of breast development, breast asymmetry, underdeveloped breasts, breast atrophy, tuberous breasts, mammary hyperplasia, fibroadenoma, giant fibroadenoma, cystosarcoma phyllodes, intra-ductal breast papilloma, adenocarcinoma, mastitis, traumatic breast disorders, benign breast disease, fibrocystic change, mastalgia, gynecomastia, and galactorrhea. A number of figures are provided illustrating breast pathologic findings. Clinicians caring for children and adolescents are encouraged to provide careful assessments of this important organ.

Bloody nipple discharge in children: possible etiologies and selection of appropriate therapy

An understanding of underlying causes of bloody nipple discharge (BND) is necessary to be able to advise treatment guidelines of this rare symptom in the pediatric age group. Of 11 patients with 14 breasts that had BND, data regarding age, sex, side and duration of BND, physical examination findings, laboratory values, culture reports, ultrasonography (US) findings, treatment approach, histopathologic details, and outcomes were obtained, and also, literature was reviewed. The patients were between 3 months and 12 years of age. There were six males and five females. The BND was located in the right breast in six patients, in the left in two, and it was bilateral in three. On physical examinations, seven patients had palpable cystic nodules located at the areolar area and three had a diffuse breast enlargement without skin findings. Laboratory investigations showed normal hormone levels in all patients. At US examinations, seven breasts had cystic lesions, three had hypoechoic tissue in the subareolar region, and others had normal US findings. In a girl with positive culture for Staphylococcus aureus, BND resolved after oral antibiotics. Two cases resolved spontaneously, with 6 months and 4 months follow-up periods, respectively. Surgical intervention was performed for the remaining eight patients, and mean time to operation after onset of symptoms was 10 months (range = 1-34 months). Histopathologic findings showed that the underlying cause of BND was duct ectasia in five breasts, gynecomastia in three, and fibrocystic change in two. Their follow-up periods ranged between 3 months and 6 years, and no recurrences were observed. Classification of breasts with BND for selecting appropriate therapy on the basis of results of careful physical examination, with an US evaluation in selected cases, is effective, and prevents unnecessary investigations.

Nonpuerperal mastitis in adolescents

Mastitis in non-lactating adolescents is rare and its cause unclear. This retrospective study summarizes 22 such episodes, in 3 of which Staphylococcus aureus was isolated. Serum prolactin levels were normal. Most patients were successfully treated with oral amoxicillin-clavulanic acid. Three patients with bilateral breast cysts had a recurrence.

Treatment of pediatric breast problems

Pediatric breast anomalies are relatively common. Treatment options depend on whether the abnormalities are hyperplastic, deformational, or hypoplastic. Hyperplastic anomalies require reduction techniques, whereas deformational and hypoplastic lesions require augmentation techniques and are more likely to require revisional surgeries. These designations aid the surgeon in decision-making about timing for treatment and in optimizing aesthetic outcomes.

Sonography of pediatric male breast masses: gynecomastia and beyond

BACKGROUND

Palpable breast masses are rare in the pediatric male population. Prior reports have described the ultrasound findings of the normal pediatric breast, masses seen primarily in female pediatric patients, and masses seen in adult males.

OBJECTIVE

To describe and illustrate the sonographic findings in gynecomastia and other causes of breast masses in a group of pediatric males.

MATERIALS AND METHODS

We reviewed the ultrasound database of a large tertiary-care children's hospital for male pediatric patients presenting with breast masses from 1994 to 2000. The findings were correlated with additional imaging and pathology results.

RESULTS

Twenty-five pediatric patients ranging in age from 1 month to 18 years were referred for breast ultrasound. Eighteen patients (72%) had gynecomastia. Two patients each (8%) had galactocele(s) or had postoperative hematoma. One patient had ductal ectasia, which resolved. One patient had periductal hemangioma. One patient with neurofibromatosis and a solid mass was lost to follow-up.

CONCLUSION

Palpable breast masses are rare in the male pediatric patient and sonography is the primary imaging modality. The overwhelming majority of these cases are adolescent boys presenting with gynecomastia. Other diagnoses such as galactocele(s), hemangiomas, and ductal ectasia should be considered when young male patients present with a palpable mass. Malignant breast lesions are rare and are likely to be metastatic or primary tumors of non-breast tissue origin.

Treatment of multiple bilateral juvenile fibroadenomas in a teenage breast by central pedicle breast reduction, with vertical and short horizontal scar: case report

An 11-year-old girl presented with extremely large and slightly asymmetric breasts that had developed over a 1-year period. The condition was diagnosed as multiple bilateral juvenile fibroadenomas on the operative field and successfully treated with central pedicle breast reduction using a vertical and short horizontal scar design. Breast function and aesthetic appearance were preserved with no reported recurrence 5 years after surgery.

The female athlete. Before and beyond puberty

As the twentieth century progressed, the female athlete became an accepted participant of sports at all levels. This article reviews various aspects of female sports participation. After an historical perspective, selected comments are provided on psychologic and physiologic aspects. Concepts of adolescent gynecology are reviewed, including breast and menstrual problems and pregnancy. Other areas reviewed include iron deficiency anemia, stress urinary incontinence, and sports injuries in female athletes.

Unusual clinical presentation of a rare case of phyllodes tumor of the breast in an adolescent girl

Phyllodes tumor of the breast is a very rare neoplasm, particularly in adolescent girls and young women. It usually presents as unilateral palpable mass. The authors report the case of an adolescent girl who presented at the Emergency Department with bloody nipple discharge. Although the clinical signs suggested an intraductal tumor, the histologic examination showed a phyllodes tumor. The management and the biologic behavior of this uncommon tumor are discussed with particular regard to the very unusual clinical presentation in this patient. J Pediatr Surg 36:941-943.

Breast US in children and adolescents

Ultrasonography (US) is of value in the evaluation and characterization of breast masses in children. Most masses represent either normal breast tissue, cysts, or fibroadenomas. Premature thelarche may be unilateral, and normal breast tissue is found at US. Cysts are commonly retroareolar; when they become infected, they appear sonographically as a complex mass. Fibroadenoma is the most frequent breast tumor in adolescent girls, and it is usually solitary, homogeneous, and hypoechoic. Malignant breast lesions are very rare in children; most are due to metastatic disease secondary to rhabdomyosarcoma, leukemia, lymphoma, and neuroblastoma, and their US appearance is nonspecific. Gynecomastia in boys can be mimicked by general obesity and pectoral hypertrophy; US is helpful in the diagnosis, especially when gynecomastia is asymmetric. Most breast lesions in children and adolescents are benign, and surgery should be avoided to prevent later deformity. US is the ideal imaging modality to evaluate breast lesions and may be used to guide a fine-needle aspiration biopsy. Color Doppler US evaluation is helpful; cysts are avascular, fibroadenomas may be avascular or hypovascular, and abscesses show peripheral increased flow. Bloody nipple discharge is more common in prepubertal patients, may occur in infants, and may be secondary to mammary ductal ectasia. Discharge commonly resolves spontaneously, and findings at US are frequently normal.

Fine-needle aspiration of breast masses. A review of its role in diagnosis and management in adolescent patients

PURPOSE

To assess the role of fine-needle aspiration biopsy (FNA) in the evaluation and management of breast masses in adolescents.

METHODS

All FNAs performed on organ masses over a 15-year period on patients age 21 years and younger were evaluated. Cases were collected from four large university-affiliated teaching hospitals and clinics. Pathology records from the laboratory information systems were reviewed. Data included clinical information, anatomic site, and cytologic diagnoses. Surgical follow-up was included when available.

RESULTS

Three hundred and twenty-five FNAs from 302 patients were reviewed. Of 325 aspirates, 59 were breast FNAs (in 51 patients: 4 males and 47 females). Among all organs, the breast was the most common one aspirated in females. Of the breast aspirates in females, 49% were diagnosed as fibroadenomas. No cases of malignant breast disease or phyllodes tumors were encountered. Surgical biopsy follow-up was available in 23.7% of the patients. Of those masses which were subsequently surgically biopsied, most were diagnosed as either fibroadenoma (11) or juvenile fibroadenoma (two). One other case biopsied showed ductal hyperplasia and adenosis. The majority of the remaining cases were followed up clinically, since the clinical nature and cytologic features of the lesions were those of fibrocystic changes or benign cysts.

CONCLUSIONS

In the series of FNAs we examined, breast masses were the most frequent lesions aspirated in adolescent females, with fibroadenomas being the most common lesion encountered. FNA proved to be a useful and reliable tool in the evaluation and management of masses involving the adolescent breast. The majority of breast masses in adolescents are benign, and lesions can be managed conservatively in this age group. The use of noninvasive diagnostic procedures such as FNA and ultrasound can reduce the need for open surgery during breast development.

Diagnosis and treatment of symptomatic breast masses in the pediatric population

Between 1980 and 1993, 74 children and adolescents were referred for surgical evaluation of palpable breast masses. Thirty-two were managed nonoperatively for unilateral thelarche (26), fibroadenoma (3), gynecomastia (2), or hemorrhagic cyst (1). The other 42 children had surgical intervention for giant or painful fibroadenomas (19), breast abscesses (5), painful gynecomastia (6), metastatic disease (4), or other conditions (8). No instances of primary breast malignancy were noted. Physical examination and minimal (selective) diagnostic testing can conserve health care dollars in cases of pediatric patients with breast masses.

Breast cancer in adolescent females

Reports of breast cancer in adolescent females consist mostly of isolated patients. Because of this, neither the prognosis nor optimal management of the disease in this age group is clear. The authors retrospectively reviewed their 40-year single-institution experience of all patients under 20 years of age who were referred for treatment of newly diagnosed breast cancer. The charts of 16 patients, all females (age range, 13 to 19 years), were reviewed. Four patients found to have cytosarcoma phyllodes and two with tumors metastatic to the breast were excluded from further study. Ten patients had various forms of adenocarcinoma of the breast, including invasive intraductal, invasive lobular, signet ring, and secretory adenocarcinoma. Four had a family history of breast cancer. The average time from onset of symptoms to diagnosis was 3.7 months. Mammography failed to diagnose cancer in any of the four patients tested, including one with an 8-cm mass. Two patients had stage I tumors, four had stage IIA, two had stage IIIA, and two had stage IV. The patients were treated with combinations of surgery, radiation therapy, and chemotherapy. One stage I patient (with bilateral breast cancer) died of radiation-induced sarcoma after treatment; the other stage I patient is alive without disease 15 years after treatment. The 5-year survival rate for stage IIA patients was 50%; that for patients with stage IIIA or IV was 0%. Five of the 10 patients presented during the past 10 years. This study constitutes the largest single institution experience with adolescent breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant cystosarcomas phyllodes of the breast in adolescent females

The authors report a case of cystosarcoma phyllodes occurring in an adolescent female, thus raising to 19 the number of reported cases. The prognosis of those composite fibro-epithelial tumours is ruled by the malignancy of the connective component: the diagnosis shows no distinctive feature compared with what can be observed in adults. The prognosis (classically better) appears in fact totally similar, justifying the same therapeutic rigour, particularly in the surgical field. A multidisciplinary approach should ensure complete recovery while limiting the harmful effects of the therapy in very young women.

Breast masses in childhood and adolescence. A presentation of 17 cases and a review of the literature

Breast masses are uncommon in the first two decades of life. 17 girls aged between 2 and 15 years who presented over a 5-year period are reviewed retrospectively. The cases comprised inflammation (11), asymmetrical gynaecomastia (1), precocious puberty (1), giant juvenile fibroadenoma (1), primary rhabdomyosarcoma (1), lymphoma (1), and metastatic neuroblastoma (1). Ultrasound was useful in all cases in identifying the abnormality and guiding any further investigation.