Recurrent juvenile fibroadenoma of the breast in an adolescent: A case report

Breast development and disorders in children and adolescents

Breast masses are infrequently encountered in pediatric and adolescent populations. Most breast masses in children are benign entities arising from embryological defects which can be managed once breast development is complete. Diagnostic and management dilemmas arise when fibroepithelial lesions of the breast are seen in clinical practice. Differentiation between a fibroadenoma and a phyllodes tumor is important to guide management. Breast cancer in children under 18 years of age is extremely rare and invasive diagnostic testing and aggressive management is only recommended when clinical suspicion of malignancy is very high. Patient and caregiver counseling plays an important role in the management of these diseases. While adult-onset breast diseases have been studied very closely, there is a dearth of literature on pediatric breast anomalies. This review aims to provide a scoping overview of the available literature on benign, fibroepithelial, and malignant lesions of the breast in pediatric and adolescent populations to help guide physicians and surgeons with decision-making regarding the diagnosis and management of pediatric breast diseases.

Clinical effect of trans-areolar resection and minimally invasive mammotome biopsy in the treatment of breast fibroadenoma and its impact on the quality of life of patients

OBJECTIVE

To explore the effects of trans-areolar resection and minimally invasive mammotome biopsy on therapeutic effect.

METHODS

A total of 131 patients with breast fibroadenoma were selected as the research subjects. Among them, 58 patients were treated by trans-areolar resection and included in group A (GA), and 73 patients were treated by minimally invasive mammotome biopsy and included in group B (GB). The changes of blood pressure, intraoperative blood loss and incision length in patients were detected before anesthesia, during resection and after operation. The pain score and operation time of patients were analyzed. The incidence of postoperative complications and the therapeutic effect were compared in the two groups. The Vancouver Scar Scale (VSS) was used to assess scar condition of patients in the two groups, and the lower the score, the more normal the skin. After operation, the satisfaction with breast appearance was assessed, and the quality of life was compared between the two groups.

RESULTS

During resection, DBP and SBP indexes of blood pressure in GA were lower than GB . The intraoperative blood loss in GA was greater than GB, and the incision length was also greater than GB. The VAS pain score in GA was higher than GB (P<0.05), and operation time was also longer than GB. The incidence of complications in GB was significantly lower than GA. The total effective rate in GB was significantly higher than GA. The scar score in GA was significantly higher than GB. The satisfaction in GB was significantly higher than GA, and the quality of life in GB was higher than GA. All P<0.05.

CONCLUSION

Compared with trans-areolar resection, minimally invasive mammotome biopsy has a better therapeutic effect on patients with breast fibroadenoma, and it can improve their quality of life more significantly.

Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report

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Diagnosis and management of giant juvenile fibroadenoma can be challenging.

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Maintaining symmetry after complete excision is tougher in developing breasts.

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Periareolar approach for subareolar fibroadenomas provides good cosmetic results.

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Benign tumor to breast size ratio up to 70% provides excellent cosmetic outcome.

Introduction

Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5–2% of all fibroadenomas.

Presentation of case

In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan.

Discussion

Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases.

Conclusion

The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.

Largest giant juvenile fibroadenoma of the breast

Juvenile giant fibroadenoma is a rare benign tumour of the breast accounting for 0.5% of all fibroadenomas. The presentation can be very dramatic and may result in breast deformity and may mimic a rare malignant tumour. It is indeed a great challenge to provide the best treatment for these patients in terms of clinical and psychological care. Meticulous surgical planning is required to ensure a fine balance between adequate resection and the best cosmetic outcome for a developing breast. Every effort should be made to preserve the developing breast irrespective of the size of the tumour as it is in this case. We report the world's largest juvenile fibroadenoma of the breast in a 16-year-old girl who presented to our hospital with a 28×25 cm mass on her left breast in which breast conservation was done. A detailed literature search and management of these lesions are discussed.