1
|
Zmora O, Klin B, Iacob C, Meital A, Mendlovic S, Karni T. Characterizing excised breast masses in children and adolescents-Can a more aggressive pathology be predicted? J Pediatr Surg 2020; 55:2197-2200. [PMID: 32061367 DOI: 10.1016/j.jpedsurg.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/22/2019] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Our aim was to characterize excised breast masses in children and adolescent and to identify factors associated with a more aggressive pathology. METHODS Retrospective review of all female patients <19 who underwent excision of breast masses at our institution between 1999 and 2018. Demographic, clinical, imaging, pathological and management data were collected. We assessed possible association of any of the variables with a more aggressive pathology (phyllodes tumor and malignancy). Correlation between core needle biopsy results and final pathology results was also calculated. RESULTS 70 patients were included. Median age was 17 years (range: 11-19). Resected mass size was 4 cm (range: 2-16). Final pathology results were: fibroadenoma (49), juvenile fibroadenoma (7), hamartoma (5), benign phyllodes (7), malignant phyllodes (1) and sarcoma (1). Pathology was benign in 61 (87%) patients and more aggressive (phyllodes and sarcoma) in 9 (13%). None of the tested variables was associated with a more aggressive pathology. Presurgical core biopsy results matched final pathology in only 63.6%. CONCLUSIONS Excised breast masses in children and adolescents are sometimes of a more aggressive pathology, which cannot be predicted by presurgical factors, including a core needle biopsy. Prognosis study LEVEL OF EVIDENCE: III.
Collapse
Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Baruch Klin
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catalin Iacob
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron Meital
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonia Mendlovic
- Department of Pathology, Shamir (Assafh Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Karni
- Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Englert EG, Ares G, Henricks A, Rychlik K, Hunter CJ. Analysis of factors predicting surgical intervention and associated costs in pediatric breast masses: a single center study. Pediatr Surg Int 2018; 34:679-685. [PMID: 29644453 DOI: 10.1007/s00383-018-4268-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Finding a breast mass in a child provokes apprehension in parents, especially in those with a family history of breast cancer. Clinicians must decide between serial imaging or biopsy of the mass. Herein, we identify management differences in those with and without a positive family history, as well as identify cost differences. METHODS An institutional retrospective review was performed of patients (2-18 years of age) with a diagnosis of breast mass. Patient demographics, presentation, medical and surgical history, physical exam, imaging, and pathologic diagnosis were collected. Cost data were acquired from the pediatric health information system (PHIS). Costs were compared between patients managed by biopsy versus serial ultrasounds. Bivariate analyses including Pearson's Chi-square, student's t tests, and logistic regression were performed. RESULTS The probability of biopsy increases with age (p = 0.0001) and female gender (p = 0.006). Biopsy rate is higher for larger masses (p < 0.0001), growing size (p < 0.0001), and in patients with a positive family history of breast cancer (p < 0.0001). The average cost of care for management with initial excisional biopsy was $4491 versus those with serial ultrasounds ($986) (p < 0.0001). CONCLUSIONS In patients with small lesions, even with a family history of breast cancer, non-operative monitoring is a safe and cost-effective alternative to invasive biopsy.
Collapse
Affiliation(s)
- E Graham Englert
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA
| | - Guillermo Ares
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA
- Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 376-CSN, Chicago, IL, 60612, USA
| | - Andrea Henricks
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA
| | - Karen Rychlik
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA
| | - Catherine J Hunter
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA.
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
- Katie N Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
4
|
Abstract
OBJECTIVE To estimate the incidence of breast carcinoma and survival in patients younger than 25 years old, and to describe presenting clinical signs and symptoms of breast cancer in this age group. METHODS A population-based descriptive study and case review in Olmsted County, Minnesota, was conducted using the resources of the Rochester Epidemiology Project. Participants were Olmsted County girls and women younger than 25 years old with histopathologically confirmed breast carcinoma diagnosed between 1935 and 2005. Nonresidents who presented to a medical facility within Olmsted County during this time period were included in some portions of the analysis. Main outcome measures were age-adjusted incidence, 5-year survival, and clinical presentation of breast carcinoma in girls and women younger than 25 years of age. RESULTS With four breast carcinomas observed in Olmsted County residents over 1,201,539 person-years, the annual age-adjusted incidence of breast cancer in this population was 3.2 per million (95% confidence interval, 0.1-6.2). All four cancers occurred in the 20- to 24-year age group (age-specific incidence, 16.2 per million). Eight additional cases of breast carcinoma were identified in nonresidents. Delay in diagnosis was common. All had at least one feature worrisome for an aggressive neoplasm identified in their clinical history, on physical examination or by imaging. CONCLUSION Breast carcinoma in young women is very rare, associated with delayed diagnosis, and usually associated with concerning features requiring biopsy. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Patricia S Simmons
- From the Divisions of Pediatric and Adolescent Gynecology and Epidemiology, Mayo Clinic, Rochester, Minnesota; the Department of Gynaecology, Royal Children's Hospital, Melbourne, Australia; and the Department of Pathology, Mayo Clinic Health System, Austin, Texas
| | | | | | | |
Collapse
|
5
|
Welch ST, Babcock DS, Ballard ET. Sonography of pediatric male breast masses: gynecomastia and beyond. Pediatr Radiol 2004; 34:952-7. [PMID: 15378216 DOI: 10.1007/s00247-004-1281-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 06/16/2004] [Accepted: 06/23/2004] [Indexed: 10/26/2022]
Abstract
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.
Collapse
Affiliation(s)
- Steven T Welch
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | | | | |
Collapse
|
6
|
Cheng JC, Esparza SD, Knez VM, Sakamoto KM, Moore TB. Severe lactic acidosis in a 14-year-old female with metastatic undifferentiated carcinoma of unknown primary. J Pediatr Hematol Oncol 2004; 26:780-2. [PMID: 15543020 DOI: 10.1097/00043426-200411000-00021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 14-year-old girl was found to have a large, non-tender breast mass with anemia and thrombocytopenia. The diagnosis of an undifferentiated carcinoma of unknown primary was made after open breast biopsy of the mass with negative immunohistochemical studies for breast malignancies. Further evaluation showed extensive metastatic disease affecting the bone marrow, ribs, liver, and brain with magnetic resonance imaging evidence of carcinomatous meningitis. Despite 2 months of chemotherapy and intensive supportive care, the patient died of severe lactic acidosis and disseminated intravascular coagulation after exaggerated menstrual bleeding. The association of severe lactic acidosis and undifferentiated carcinoma of unknown primary in an adolescent has not been previously described.
Collapse
Affiliation(s)
- Jerry C Cheng
- Division of Pediatric Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | | | | | | | | |
Collapse
|