Large breast tumors in adolescent females

Fibroepithelial Lesions in the Breast of Adolescent Females: A Clinicopathological Study of 54 Cases

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.

Metastasis of Mammary Gland Malignant Phyllodes Tumor to the Mandibular Region: A Case Report and Review of the Literature

Phyllodes tumor is a rare breast tumor described by Müller (1938) as a lesion comprising leaflike stromal fibrous components and narrow cysts. The frequency of distant metastasis from this entity is reportedly approximately 20%, and no effective therapy has been established, so the prognosis is poor. This report describes the case of a 60-year-old woman with a history of left lung resection who showed metastasis of a mammary gland malignant phyllodes tumor to the oral cavity. Intraoral examination showed an elastic, hard mass measuring 28 × 27 mm in the gingiva around the left mandibular second molar. Biopsy examination showed growth of giant cells and roughly circular cells showing positivity for S-100, p63, and vimentin on immunohistochemical staining. The authors diagnosed metastasis of the mammary gland malignant phyllodes tumor to the left mandible and performed cyber knife irradiation (44 Gy in 5 fractions) of the left mandible. The mass in the oral cavity disappeared after cyber knife irradiation, but the patient died of direct invasion to the spine.

Malignant Phyllodes Tumor of the Breast

Phyllodes tumors of the breast are rare lesions that historically have been presumed to be related to fibroadenomata, largely by virtue of the entities' histologic similarities. We report four cases of malignant phyllodes tumors (cystosarcoma phyllodes) of the breast, three showing liposarcomatous differentiation and one showing chondrosarcomatous and osteosarcomatous differentiation, each of which had demonstrable histologic continuity with benign fibroadenomata; one patient had a prior and concurrent history of multiple bilateral fibroadenomata. We postulate that fibroadenomata and phyllodes tumors (benign, borderline, and malignant) may constitute a spectrum of one stromal disease analogous to mammary epithelial hyperplasia, atypical hyperplasia, in situ, and invasive carcinoma. Int J Surg Pathol 3(1):17-22, 1995

Massive bilateral breast reduction in an 11-year-old girl: 24% ablation of body weight

An 11-year-old girl with massive virginal breast hypertrophy is presented. The breasts had begun to grow rapidly at puberty and had reached an enormous size within a year, to the point of causing physical impairment and respiratory compromise. Routine blood chemistry and endocrine investigation was normal, as was an MRI scan of the pituitary fossa. A bilateral reduction mammaplasty with free nipple grafts was performed, removing 12.5 kg of tissue in all (24% of the total body weight). There was no recurrence at a 2 year follow up, and no requirement for additional surgery. A review of the literature reveals that breast regrowth is less frequent when free nipple grafting is used, and this technique is recommended for these extraordinary cases.

Bilaterally symmetric juvenile fibroadenomas and tubular breast deformity in a prepubescent girl

Juvenile fibroadenomas are rare and usually not associated with other disease processes. We report the first known case of bilateral juvenile fibroadenomas in conjunction with tubular breast deformity in a prepubescent girl.

Giant fibroadenoma of the breast in an Arab population

In a retrospective study of giant breast masses over a period of 20 years (1980-2000), we encountered 18 patients with fibroadenomas. Most of them were adolescents and young adults. The bimodal age incidence seen in Caucasians was not observed. The masses ranged from 6 to 15 cm in size and in the youngest patient, they were bilateral. All 18 patients were examined by mammography and 10 of them by ultrasonography (US) as well. The right breast was involved in 12 patients and the left in six. The diagnosis was confirmed pathologically in all patients, by excision biopsy in 17 patients and by fine needle aspiration cytology and excision biopsy in one patient. The radiological findings were the same as those previously described. All patients were treated by simple enuculation. There was only one recurrence over a follow-up period from 2 months to 3 years.

Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients

Cystosarcoma phyllodes (CP) is an uncommon tumor in adolescent girls and young women. This study seeks to define the clinical and pathologic features of CP in this unusual clinical setting. Forty-five CPs (34 benign and 11 malignant) in prepubertal and adolescent girls and young women were studied. Classification of the tumors was based on the following morphologic features: stromal cellularity, nuclear atypia, mitotic activity, necrosis, and the nature of tumor borders. Surgical therapy was local excision or mastectomy. The age of the patients ranged from 10 to 24 years (mean 17.7). The tumors measured 1.4 cm to 10.2 cm at their widest point (mean 4.6). Both breasts were affected equally. Thirty-two patients were treated by local excision with or without reexcision and four patients by mastectomy. Follow-up was available for 36 patients for a mean of 58.4 months. Local recurrence was reported in six of the 36 cases (16%) (four benign and two malignant). The six patients with recurrent disease had infiltrative tumor borders and positive surgical margins microscopically. There was a single instance of systemic metastases from a high-grade malignant tumor with rhabdomyosarcomatous stromal differentiation and a high mitotic rate. At last follow-up, 34 patients were alive with no evidence of disease, one patient was alive with pulmonary metastases, and one patient died of an unrelated cause. We concluded that CP in adolescent girls and young women is not more aggressive than in older patients. Infiltrative tumor borders and positive surgical margins are the best histologic predictors for local recurrence. Mitotic activity is the most important criterion for assessing the metastatic potential. CP in this age group should be treated to maximize breast conservation. Mastectomy may be required to obtain clear margins for CPs that cannot be managed by excision because of large tumor size relative to breast volume.

Breast masses in adolescent females

In a retrospective study of 38 adolescent females operated on for mammary masses, 42 fibroadenomata (FA), 2 fibrous scars around abscesses, and one papilloma were found. All were postmenarchal. Clinical and pathological features were reviewed and the patients reexamined or interviewed. FA were mostly asymptomatic and removed a few weeks after incidental discovery. They were often seen in Jewish girls of parents born in North Africa and the Middle East, and were more frequently located in the outer superior quadrant of the left breast. New FA appeared in almost half of the cases later on in the same breast, as well as in the other breast, or bilaterally. Necrosis occurred in three FA and was unrelated to the size of the tumor. There was no correlation between the size of FA, multiplicity, or necrosis, nor between increased stromal or epithelial atypia, cellularity, or mitotic activity. One explanation for the high rate of multiplicity might be related to this neoplasm occurring in an actively developing organ under hormonal control. There was no increased breast carcinoma apparent in the family history. Therefore, except in cases of fast-growing tumors, a conservative approach is recommended because of the frequency of multiple FA as well as aesthetical postoperative complications.

Virginal breast hypertrophy at puberty; a case report

Plastic surgery reduction with free nipple graft was performed on an eleven and a half-year-old girl referred to us with massive bilateral macromastia. Hormonal studies revealed no abnormalities. Histopathological examination confirmed the diagnosis of virginal hypertrophy, an infrequent etiology in adolescent macromastia.

Breast disorders in children and adolescents

A review of pediatric breast disorders is provided, with particular attention given to the topics of fibroadenoma, cystosarcoma phylloides, breast infections, breast cancer, and benign breast disease. The pediatric clinician is strongly encouraged to include the breast system as part of a complete examination and educational process.

Malignant cystosarcoma phyllodes of the breast metastatic to the oral cavity: report of a case and review of the literature

A case report involving an oral lesion that was found to be histologically identical to the stromal component of malignant metastatic cystosarcoma phyllodes of the breast is described. This represents the first reported histologically confirmed oral manifestation of an extremely rare breast tumor. The literature regarding oral manifestations of metastatic disease in general and of cystosarcoma phyllodes in particular is reviewed.

Surgical problems in the management of giant fibroadenoma of the breast

Giant intracanalicular fibroadenoma is reported to be the most common cause of a massive, deforming enlargement of one breast in the female adolescent. It occurs infrequently and has a varied histopathologic pattern. It is suggested that obstetricians and gynecologists should have an awareness of this potentially malignant tumor of the breast with its associated problems of diagnosis and surgical management. Consideration of these huge breast tumors in relation to other similar breast lesions is presented in order to emphasize differential characteristics and treatment.

Cystosarcoma phylloides in adolescent female patients

Nine cases of cystosarcoma phylloides in adolescent female patients are reported along with an additional 35 cases collected from the literature. Analysis of these 44 cases revealed 37 (84.1 percent) benign lesions, 6 (13.6 percent) malignant tumors, and 1 borderline lesion. Excision was the most common operative procedure and was performed in 35 patients. Nine patients underwent mastectomy. There were three recurrent lesions (one benign and two malignant) for a recurrence rate of 6.8 percent. Wide excision was successful in the treatment of recurrent lesions. On the basis of these data, excision is the preferred initial therapy of cystosarcoma phylloides in the adolescent patient regardless of the histologic classification of the lesion. Malignant cystosarcoma is more likely to recur than a benign lesion but a recurrence can be managed with reexcision. Sacrifice of the adolescent breast at the initial procedure is strongly discouraged.

Metastatic cystosarcoma phylloides in an adolescent girl: an unusually malignant tumor

The first case of metastatic cystosarcoma phylloides in an adolescent is reported. This case also represents the first reported response of this tumor to chemotherapy and irradiation. This tumor showed an unusually rapid rate of cell division probably making it more susceptible to these agents. The importance of an early diagnosis and definitive excision is stressed.

Giant fibro-adenoma (cystosarcoma phyllodes) in adolescent females--a clinicopathological study

1. An analysis of the findings in a series of 25 cases of giant fibro-adenoma of the breast in adolescent females is presented together with a review of the relevant literature. The clinical features, histology, prognosis and treatment of these tumours are discussed.

2. Follow-up of from 2 to 8 years after total excision of the tumours has shown that normal breast development occurred in all the cases. There was no recurrence or distant metastasis.

3. Despite clinical features and histological characteristics suggestive of malignancy the tumour has been found in our experience to be strictly benign in patients under the age of 20 years.

Malignant cystosarcoma phyllodes in a pre-pubertal female

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