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Harper LK, Simmons CL, Woodard GA, Solanki MH, Bhatt AA. Pictorial Review of Common and Uncommon Pediatric Breast Lesions. Radiographics 2023; 43:e220117. [DOI: 10.1148/rg.220117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura K. Harper
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Curtis L. Simmons
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Genevieve A. Woodard
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Malvika H. Solanki
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Asha A. Bhatt
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
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2
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Pediatric chest wall masses: spectrum of benign findings on ultrasound. Pediatr Radiol 2022; 52:429-444. [PMID: 34505950 DOI: 10.1007/s00247-021-05196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.
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3
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Morikawa H, Nobuoka M, Amitani M, Shimizu T, Ohno K, Ono M, Oba T, Ito T, Kanai T, Maeno K, Uehara T, Ito K. Fibroadenoma in a young male breast: A case report and review of the literature. Clin Case Rep 2021; 9:e05114. [PMID: 34840799 PMCID: PMC8605269 DOI: 10.1002/ccr3.5114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/23/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
Fibroadenomas are the most common benign breast tumors in women, but rarely occur in men. Herein, we present a case of fibroadenoma occurring in a young, healthy male without hormonal alterations. This indicates that fibroadenoma should be regarded as differential diagnosis for tumors in the male breast.
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Affiliation(s)
- Hiroki Morikawa
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Megumi Nobuoka
- Division of Laboratory MedicineShinshu University HospitalMatsumotoJapan
| | - Masatsugu Amitani
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Tadafumi Shimizu
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Koichi Ohno
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Mayu Ono
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Takaaki Oba
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Tokiko Ito
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Toshiharu Kanai
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Kazuma Maeno
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
| | - Takeshi Uehara
- Division of Laboratory MedicineShinshu University HospitalMatsumotoJapan
| | - Ken‐ichi Ito
- Division of Breast and Endocrine SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumotoJapan
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4
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Restrepo R, Cervantes LF, Swirsky AM, Diaz A. Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation. Pediatr Radiol 2021; 51:1959-1969. [PMID: 34236480 DOI: 10.1007/s00247-021-05099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/01/2021] [Accepted: 05/02/2021] [Indexed: 10/20/2022]
Abstract
Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA.
| | - Luisa F Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA
| | | | - Alejandro Diaz
- Division of Pediatric Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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5
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Ait Ichou J, Gauvin S, Faingold R. Ultra-high-frequency ultrasound of superficial and musculoskeletal structures in the pediatric population. Pediatr Radiol 2021; 51:1748-1757. [PMID: 33666733 DOI: 10.1007/s00247-021-04978-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
Because of its relatively low cost, lack of ionizing radiation and great versatility, US is considered the imaging modality of choice to evaluate a large variety of pediatric conditions. Imaging of superficial structures and small anatomical parts can be at times limited with standard US. Recent advances in technology yielded ultra-high-frequency US systems that are capable of scanning with frequencies as high as 70 MHz and resolutions of 30 μm. This technology, approved by the United States Food and Drug Administration, has not been widely used in the clinical setting. It has the potential to become a powerful diagnostic tool in clinical practice, especially in the evaluation of infants, given their inherent body habitus. Our main objective is to discuss the use of ultra-high-frequency US at a tertiary care center. This pictorial essay presents a gamut of pediatric pathologies pertaining to imaging of the soft tissues and the superficial and musculoskeletal structures. Our aim in this pictorial essay is to highlight and illustrate the role of ultra-high-frequency US in improving the depiction of common and less common pathologies. We think it also helps to gain a new understanding of the normal anatomy in the pediatric population and to display specific features not shown by standard US and, in certain cases, ones that lead to a change in diagnosis.
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Affiliation(s)
- Jamal Ait Ichou
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.
| | - Simon Gauvin
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Ricardo Faingold
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.,Department of Diagnostic Radiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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6
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D'Auria D, Ferrara D, Aragione N, De Chiara C, Argenziano G, Noschese I, Noviello D, Esposito F. Role of ultrasound in diagnosis of neonatal breast enlargement: a newborn case report. Radiol Case Rep 2021; 16:2692-2696. [PMID: 34336074 PMCID: PMC8318999 DOI: 10.1016/j.radcr.2021.06.057] [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: 06/06/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022] Open
Abstract
Neonatal breast enlargement is a hormone-related condition, mostly asymptomatic\physiological, with a well-recognizable sonographic appearance but limited data in the literature. It can be uni-or bilateral. Typically described in the first week of life, the transient lesion disappears spontaneously within 6 months. The main differential diagnosis is neonatal mastitis, a breast tissue infection that requires a specific antibiotic therapy. Knowledge of clinical and imaging findings is crucial, and ultrasound represents a reliable tool which allows a quick identification and an excellent examination of neonatal breast abnormalities. We aim to highlight sonographic classic features of benign neonatal breast enlargement showing how ultrasound rules out real breast masses helping to differentiate between it and mastitis when clinical and laboratory data are inconclusive. We describe a 2-day-old male with bilateral breast swelling more pronounced on the right side.
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Affiliation(s)
- Divina D'Auria
- Department of Advanced Biomedical Sciences, Federico II University Unina, Via Sergio Pansini, Naples, Italy
- Corresponding author.
| | - Dolores Ferrara
- U.O. Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Nunzia Aragione
- Department of Neonatal Pathology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Carolina De Chiara
- Department of Neonatal Pathology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Gioconda Argenziano
- U.O. Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Ivan Noschese
- Department of Advanced Biomedical Sciences, Federico II University Unina, Via Sergio Pansini, Naples, Italy
| | - Domenico Noviello
- U.O. Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Francesco Esposito
- U.O. Emergency Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
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7
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Alawi A, Hasan M, Harraz MM, Kamr WH, Alsolami S, Mowalwei H, Salem A, Qronfla H. Breast lesions in women under 25 years: radiologic-pathologic correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00209-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The majority of breast lesions in women under 25 years are being benign. Imaging is important for diagnosis and selecting patients for further procedures. Although malignancy is rare in this group of patients, suspected lesions must be biopsied. Imaging is very important in the selection of patients for radiological intervention. Understanding of the clinical, pathologic, and imaging features allows the radiologist to guide proper management of these patients. The aim of this study was to determine the frequency of different breast lesions in symptomatic women under 25 years and the value of radiological imaging in the diagnosis.
Results
This was a retrospective study; a total number of 250 cases with breast lumps under 25 years of age were registered in the PACKS of our institution in the period from January 01, 2017 to December 31, 2018. Two hundred three cases coped with our inclusion criteria that include available histopathological results either by biopsy or after surgery based on their referring physicians decision. Our exclusion criteria were those cases (47) with definite BIRADS 2 lesions with no available pathology reports. Ultrasonography was done to all patients (203 cases) and MRI was performed to 26 cases. All cases were histologically verified; their findings were reviewed and compared to radiological findings.
A total of 203 symptomatic breast lesions were received at the radiological department in women under 25 years; there were 115 (56.7%) benign, 85 (41.9%) cystic, and 3 (1.5%) malignant lumps. The commonest benign lesion was fibroadenoma (104 cases, 51.2%) and all the malignant lesions were invasive ductal carcinoma (IDC) (3 cases, 1.47%). The p value is > 0.05, so there were no differences between examination using the ultrasonography and the MRI imaging compared to histopathological results.
Conclusions
Most breast lesions in young women are benign. Ultrasonography is an essential first imaging modality in the diagnosis of women under 25 years with breast lesions.
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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.
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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
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9
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Olarinoye-Akorede SA, Ibinaiye PO, Suleiman LB. Ultrasonographic review of pediatric breast masses among Nigerian children in a tertiary hospital. Afr J Paediatr Surg 2020; 17:54-58. [PMID: 33342834 PMCID: PMC8051630 DOI: 10.4103/ajps.ajps_57_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Breast masses occur infrequently in children and adolescents. Most of these masses have proved that benign and conservative approach is the management of choice. Consequently, imaging has become crucial. The knowledge of the ultrasonographic features of childhood and adolescent breast masses is needed for age appropriate medical care. AIM The aim of this study was to describe and document the ultrasonographic spectrum of breast masses in children and adolescents (0-19) years seen in the Ahmadu Bello University teaching hospital, Zaria. MATERIALS AND METHODS A 2-year retrospective review of breast sonograms of 25 consecutively presenting children and adolescents (3 males and 22 females) who had palpable breast masses. Ultrasound scans were performed with a Mindray Machine DC-8 using the linear transducer at 7.5-12 MHz transducer frequency. Histopathological confirmation of the solid masses was also obtained. The statistical analysis of the data collected was done using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA). RESULTS The patients were between 40 days and 19 years old (mean 14.8 years and standard deviation 4.1). The ultrasonographic findings were those of infections, benign tumoral lesions and pubertal endocrine changes. Overall, fibroadenoma was the most common mass, seen in 14 (56%) of the patients. Other findings were simple cysts, non-puerperal and puerperal mastitis, juvenile papillomatosis and normal glandular pubertal breast tissue. The three male patients had gynaecomstia, pseudogynaecomastia and cystic lymphangioma of the chest wall presenting as unilateral breast masses, respectively. There was no malignancy recorded in any of the patients. CONCLUSION Ultrasonographically, benign masses predominate which is concordant with surgical findings. Familiarity with these features would obviate the need for unnecessary invasive procedures which should be reserved for only deserving cases.
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Affiliation(s)
| | | | - Lawal B Suleiman
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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10
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Wright AG, Hayward JH, Price ER, Ray KM, Joe BN, Lee AY. Primum non nocere: Utility and outcomes of pediatric breast ultrasound. Clin Imaging 2020; 68:131-135. [PMID: 32599442 DOI: 10.1016/j.clinimag.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the use and outcomes of ultrasound for the evaluation of breast signs and symptoms in pediatric females. METHODS A retrospective database review identified all patients ≤18-years-old who underwent breast ultrasound at an academic institution over a 20-year period. Each symptomatic site was designated a case and analyses were performed on each case. Imaging findings were obtained from the radiology reports. Clinical and pathology data were obtained from the medical records. Descriptive statistics were performed. RESULTS The final cohort comprised 124 cases in 101 patients. Mean age was 15 years (range 1-18). The most common indication for ultrasound was a palpable lump (71%). Thirty-seven cases (30%) demonstrated no sonographic correlate to the symptom; 36 (29%) had a benign correlate. The most common benign correlates were abscess/phlegmon and cyst. All cases of abscess/phlegmon had infectious symptoms. Fifty-one cases (41%) demonstrated a sonographic mass that was not characteristically benign. Of these indeterminate masses, 27 were recommended for biopsy, 13 for short-interval follow-up, and 6 had no recommendation. Of 27 biopsied masses, 63% were fibroadenomas. No symptoms were due to malignancy. Therefore, the NPV of ultrasound was 100% and the PPV 0%. CONCLUSION In this cohort of pediatric and adolescent patients, malignancy was never the cause of breast symptoms. Imaging yielded false positives with a biopsy recommendation in 22% of cases. Ultrasound provided value in evaluating infectious symptoms. Given the extreme rarity of breast cancer in this population, surveillance may be a safe alternative for most indeterminate lesions.
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Affiliation(s)
- Alexandra G Wright
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Elissa R Price
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Kimberly M Ray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
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11
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Moon S, Lim HS, Ki SY. Ultrasound Findings of Mammary Duct Ectasia Causing Bloody Nipple Discharge in Infancy and Childhood. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2793-2798. [PMID: 30768798 DOI: 10.1002/jum.14970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 06/09/2023]
Abstract
Bloody nipple discharge in infancy and childhood is extremely rare, and mammary duct ectasia is the most common etiology. Ultrasound (US) findings of mammary duct ectasia include dilated ducts and tubular anechoic lesions that may contain echogenic debris in the subareolar region. However, mammary duct ectasia may show variable US findings, which are not well described in the literature. We report 3 cases of mammary duct ectasia in infancy and childhood with variable imaging findings, including complex cystic and solid lesions. Detailed initial clinical and US findings and serial follow-up US images are described.
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Affiliation(s)
- Sungmin Moon
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - So Yeon Ki
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
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12
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Abstract
Neonatal breast enlargements have varying number of presentations on imaging and these have been underreported in the literature. Our case report profiles a 2-week-old female who presented with a history of bilateral breast enlargement with redness and clear, non-bloody, milk-like discharge, who was clinically diagnosed and managed for neonatal mastitis, which was actually a neonatal breast enlargement only. Awareness on neonatal breast enlargement that can be just physiological without any associated mastitis or inflammatory/infective changes can prevent unnecessary hospitalization and treatment with parenteral antibiotics.
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Affiliation(s)
- Bhumika Suthar
- Department of Radiodiagnosis, Baroda Medical College, Maharaja Sayajirao University, Vadodara, India
| | - Kanishka Aggarwal
- Department of Radiodiagnosis, Baroda Medical College, Maharaja Sayajirao University, Vadodara, India
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13
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Omar L, Pfeifer CM, Kulkarni S, Sharma P, Sengupta A, Kwon JK. Granular cell tumor in a premenstrual female breast. Clin Imaging 2018; 52:334-336. [DOI: 10.1016/j.clinimag.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/15/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
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14
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Bruserud IS, Roelants M, Oehme NHB, Eide GE, Bjerknes R, Rosendahl K, Júlíusson PB. Ultrasound assessment of pubertal breast development in girls: intra- and interobserver agreement. Pediatr Radiol 2018; 48:1576-1583. [PMID: 29982956 DOI: 10.1007/s00247-018-4188-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound (US), aiming for a more objective analysis. However, information regarding its reliability is lacking. OBJECTIVE To examine intra- and interobserver agreement of breast maturity staging using US and to examine the precision of direct measurements of the gland. MATERIALS AND METHODS Fifty-seven healthy girls (mean age: 10.9 years, range: 6.1 to 15.9 years) were examined independently by two observers using US of the left breast to score the glandular maturity stage on a 0-5 scale, and to measure the depth and diameter. One observer repeated the examination after 20 to 35 min to assess intra-observer agreement. Cohen's kappa with linear weights was used to examine intra- and interobserver agreement of the US staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement. RESULTS The agreement of US staging on a 0-5 scale was very good (kappa 0.84; 95% confidence interval [CI] 0.78-0.91) for intra-observer observation and good (kappa 0.71; 95% CI 0.62-0.80) for interobserver observation. Measurements of glandular depth and diameter were unbiased for a single observer, but the variances were large both within and between observers. CONCLUSION US using a scale from 0 to 5 is a reliable method to stage the development of glandular breast tissue during puberty in healthy girls. Measurements of glandular depth and diameter were found to be imprecise.
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Affiliation(s)
- Ingvild Særvold Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ninnie Helén Bakken Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
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15
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Lee EJ, Chang YW, Oh JH, Hwang J, Hong SS, Kim HJ. Breast Lesions in Children and Adolescents: Diagnosis and Management. Korean J Radiol 2018; 19:978-991. [PMID: 30174488 PMCID: PMC6082765 DOI: 10.3348/kjr.2018.19.5.978] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 11/15/2022] Open
Abstract
Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.
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Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jung Hee Oh
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
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16
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Durmaz E, Öztek MA, Arıöz Habibi H, Kesimal U, Sindel HT. Breast diseases in children: the spectrum of radiologic findings in a cohort study. Diagn Interv Radiol 2018; 23:407-413. [PMID: 29033391 DOI: 10.5152/dir.2017.17033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to investigate the spectrum of radiologic findings and referral reasons for breast diseases in children considering age-appropriate presentation. METHODS Our retrospective cohort study included 348 consecutive pediatric patients aged <19 years (median, 13 years) referred to radiology with a clinical presentation between 2005 and 2016. Radiologic findings were reviewed in four age ranges (0-2 years, 2-8 years, 8-15 years, >15 years). RESULTS Of 348 patients, 257 had a referral reason. The most frequent referral reason was a palpable mass (35%). Developmental abnormalities accounted for 48% of all radiologic findings in 348 patients. We did not detect any breast malignancy. According to age groups, the most common radiologic findings were neonatal hypertrophy (0-2 years), early breast development (2-8 years), developmental abnormalities by a majority of gynecomastia (8-15 years), and normal findings or developmental abnormalities (>15 years). Interestingly, the frequency of gynecomastia was only 4% in neonatal period or early childhood. Fibroadenomas and fibroadenoma-like solid masses were seen after 8 years and constituted the majority of solid masses (65%). Cysts were seen at a rate of 7% and majority of them were of simple type, which tends to resolve in time. CONCLUSION In our study, the most common referral reason to radiology was a palpable breast mass. Neonatal hypertrophy and early breast development in younger children, and developmental abnormalities in older children may be kept in mind as the most common radiologic findings. Our study confirms the substantial absence of malignancies in children as well as a widely different disease spectrum in comparison with the adult population.
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Affiliation(s)
- Emel Durmaz
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey.
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17
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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.
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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.
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18
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Lee JY. Giant phyllodes tumor of the breast with diffuse myxoid changes in an adolescent girl: a case report. J Surg Case Rep 2017; 2017:rjx019. [PMID: 28458828 PMCID: PMC5400461 DOI: 10.1093/jscr/rjx019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/24/2017] [Indexed: 12/04/2022] Open
Abstract
Giant phyllodes tumors (PT) are an uncommon fibroepithelial neoplasm and especially rare in adolescent girls. Diagnosis is difficult not only due to the rarity of PT, but also owing to the resemblance of its clinical and imaging features with fibroadenoma. The author reports a case of a giant PT in a 14-year-old girl. Clinical examination showed a large painful mass in the left breast, and an abscess was initially suspected. But magnetic resonance imaging (MRI) displayed features characteristic of PT. Following complete surgical excision of the mass, histopathology confirmed the diagnosis of a benign PT with diffuse myxoid changes, consistent with the MRI findings. This case emphasizes the importance of breast MRI, both for its ability to aid diagnosis, as well as its benefits in guiding the surgical plan.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Gyeonggi-do 10380, Republic of Korea
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19
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Rafeek N, Rangasami R, Dhanraj K, Joseph S. Multimodality approach in the diagnosis and management of bilateral giant juvenile breast fibroadenoma. BMJ Case Rep 2016; 2016:bcr-2016-217588. [PMID: 27758851 DOI: 10.1136/bcr-2016-217588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Juvenile giant fibroadenoma is a very rare breast disease affecting young girls of premenarche and adolescent ages. It is a benign fibroepithelial tumour characterised by stromal and epithelial proliferation that causes rapidly growing breast mass. Bilateral symmetrical involvement is extremely rare. In this article, we describe this entity in a girl aged 13 years who presented with bilateral gigantically enlarged breasts. Ultrasonography and MRI showed large, multilobulated masses involving both breasts entirely. Endovascular embolisation of bilateral internal mammary arteries and lateral thoracic arteries supplying the masses was performed prior to surgery to reduce their vascularity. The patient subsequently underwent excision of bilateral breast masses and reduction mammoplasty. Histopathologically, bilateral breast masses were confirmed to be juvenile fibroadenomas.
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Affiliation(s)
- Noora Rafeek
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Rajeswaran Rangasami
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Kamakshi Dhanraj
- Department of Plastic and Reconstructive Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Santhosh Joseph
- Department of Neuro and Interventional Radiology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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20
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Valeur NS, Rahbar H, Chapman T. Ultrasound of pediatric breast masses: what to do with lumps and bumps. Pediatr Radiol 2015; 45:1584-99; quiz 1581-3. [PMID: 26164440 DOI: 10.1007/s00247-015-3402-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/15/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
The approach to breast masses in children differs from that in adults in many ways, including the differential diagnostic considerations, imaging algorithm and appropriateness of biopsy as a means of further characterization. Most pediatric breast masses are benign, either related to breast development or benign neoplastic processes. Biopsy is rarely needed and can damage the developing breast; thus radiologists must be familiar with the imaging appearance of common entities so that biopsies are judiciously recommended. The purpose of this article is to describe the imaging appearances of the normally developing pediatric breast as well as illustrate the imaging findings of a spectrum of diseases, including those that are benign (fibroadenoma, juvenile papillomatosis, pseudoangiomatous stromal hyperplasia, gynecomastia, abscess and fat necrosis), malignant (breast carcinoma and metastases), and have variable malignant potential (phyllodes tumor).
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Affiliation(s)
- Natalie S Valeur
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Teresa Chapman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA. .,Department of Radiology, Seattle Children's Hospital, Mail Stop MA.07.220, P.O. Box 5371, Seattle, WA, 98145, USA.
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21
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How to approach breast lesions in children and adolescents. Eur J Radiol 2015; 84:1350-64. [DOI: 10.1016/j.ejrad.2015.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 04/10/2015] [Accepted: 04/11/2015] [Indexed: 12/25/2022]
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Abstract
The varying presentations of neonatal breast enlargement on imaging have been underreported in the literature. Our case report profiles a 3-week-old female patient who presented with a history of left breast enlargement with redness and tenderness for 2 days, who was clinically diagnosed and managed for neonatal mastitis, which was actually a neonatal breast enlargement with adjacent cellulitis. Awareness that physiologic neonatal breast enlargement can be associated with adjacent cellulitis without mastitis can prevent unnecessary hospitalization and treatment with parenteral antibiotics.
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Affiliation(s)
- Anugayathri Jawahar
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Aruna Vade
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois, USA
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23
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Abstract
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.
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Affiliation(s)
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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24
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Abstract
The authors discuss benign breast abnormalities in the adolescent breast other than fibroadenoma. Although fibroadenoma is the most common benign abnormality in the adolescent breast, other diagnoses are possible. The majority of adolescents who present with a palpable concern or lump have no discrete abnormality on ultrasound and are diagnosed with clinical fibrocystic change and followed up to ensure clinical stability. Intraductal papilloma and duct ectasia are two benign abnormalities associated with bloody nipple discharge, occurring more rarely in adolescents compared with adult women. Breast infections can occur in adolescents, including both mastitis and/or abscess, and are treated similarly to adults, with drainage and antibiotic coverage for Staphylococcus. When infections are due to nipple piercing, other organisms should be suspected. All surgical procedures in the developing breast should be performed cautiously, as trauma to the undeveloped breast can result in failure of breast development or asymmetry, and surgical disruption of subareolar ducts can impair or preclude future lactation.
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Affiliation(s)
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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25
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Jung Y, Chung JH. Mammary duct ectasia with bloody nipple discharge in a child. Ann Surg Treat Res 2014; 86:165-7. [PMID: 24761426 PMCID: PMC3994622 DOI: 10.4174/astr.2014.86.3.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 09/27/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022] Open
Abstract
Mammary duct ectasia is a rare disease in children and often presents as a cystic mass with bloody nipple discharge. The pathophysiology of mammary duct ectasia is unclear, and the differential diagnosis of other cystic masses with hemorrhage, such as complicated lymphangioma, is necessary. Here, we report a 14-month-old boy who exhibited unilateral mammary duct ectasia with bloody nipple discharge that was treated with surgical excision. Because some authors have reported that mammary duct ectasia can be often be resolved without surgery, conservative therapy should be considered first when a child presents with a cystic mass with bloody nipple discharge. However, the optimal duration of follow-up and timing of surgical excision have not yet been established.
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Affiliation(s)
- Yoonju Jung
- Department of Pediatric Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Hee Chung
- Department of Pediatric Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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26
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27
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Pediatric and Adolescent Breast Masses: A Review of Pathophysiology, Imaging, Diagnosis, and Treatment. AJR Am J Roentgenol 2013; 200:W204-12. [DOI: 10.2214/ajr.12.9560] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Bloody nipple discharge in infancy: a case report and recommendations for management. J Pediatr Adolesc Gynecol 2013; 26:16-8. [PMID: 21945629 DOI: 10.1016/j.jpag.2011.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 07/21/2011] [Indexed: 11/24/2022]
Abstract
We report a 5-month-old male infant with benign unilateral bloody nipple discharge, and we present a brief review of 20 previously described cases of bloody nipple discharge in infancy. On the basis of our case and previous reports, we offer recommendations for the management of the bloody nipple discharge in the first year of life: (1) diagnosis should be based on noninvasive diagnostic procedures, in the absence of dubious ultrasound or cytological diagnostic findings; (2) the condition resolves spontaneously, and surgical intervention should be avoided; (3) manipulation of the nipple can prolong the bleeding; (4) antibiotics should be given only in the presence of clear clinical and cytological signs of infection; and (5) parent reassurance is an important part of infantile bloody nipple discharge management.
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Abstract
Rhabdomyosarcoma rarely metastasizes to the breast. We report a case of a pediatric patient who initially presented with a right breast mass and pancytopenia, which was subsequently diagnosed as alveolar rhabdomyosarcoma. Despite initial favorable response to chemotherapy, a new metastatic focus was found in the contralateral breast 10 months later.
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30
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Izadpanah A, Karunanayake M, Izadpanah A, Sinno H, Gilardino M. An atypical growth of a giant fibroadenoma after trauma. J Pediatr Adolesc Gynecol 2012; 25:e115-7. [PMID: 22980414 DOI: 10.1016/j.jpag.2012.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fibroadenomas are the most common benign breast lesion in female adolescents. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can spontaneously infarct leading to significant morbidity and are also difficult to distinguish from the more aggressive phyllodes tumors. CASE We describe the first case, to the best of our knowledge, of a 12-year-old girl who presented with a giant fibroadenoma complicated by a central infarct and an intra-lesional hemorrhage from a trauma to the breast. SUMMARY AND CONCLUSION The complicated giant fibroadenoma with an intra-lesional hemorrhage has characteristics of both benign and malignant lesions, and is difficult to distinguish by history and physical alone. Ultrasonography is a valuable tool yet the core needle biopsy remains the gold standard to confirm the diagnosis.
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Affiliation(s)
- Ali Izadpanah
- Division of Plastic and Reconstructive Surgery, McGill University, McGill University Health Centre, Montreal, Quebec, Canada.
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31
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Cabello C, Alvarenga M, Alvarenga CA, Duarte GM, Pereira PN, Marshall PS. Case report and review of the literature: secretory breast cancer in a 13-year-old boy--10 years of follow up. Breast Cancer Res Treat 2011; 133:813-20. [PMID: 22083230 DOI: 10.1007/s10549-011-1869-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022]
Abstract
Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.
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Affiliation(s)
- Cesar Cabello
- University of Campinas, Av. Alexander Flemming, 101, Cidade Universitária, Campinas, SP 13083-881, Brazil.
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McHoney M, Munro F, Mackinlay G. Mammary duct ectasia in children: report of a short series and review of the literature. Early Hum Dev 2011; 87:527-30. [PMID: 21550735 DOI: 10.1016/j.earlhumdev.2011.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mammary duct ectasia is uncommon in children, and is usually considered to be an acquired disease in adults. However the occurrence in infants and children suggest it may be developmental. AIMS To report a case series of mammary duct ectasia, and review the published literature to ascertain the common findings and histological findings in children. STUDY DESIGN Case series report and review of the literature. RESULTS We report three cases of mammary duct ectasia, an unusual disease in children. The most common presenting features are a bloody nipple discharge; there may also be a palpable mass or general breast enlargement. Two patients in this series presented with large masses simulating other conditions. Summary of all reported cases in children found that symptoms can arise from infancy, but is most common around the age of 3 years (range 2 months to 13 years), with a 5:2 male:female ratio. Histology centres on peri-ductal inflammation and dilation. Haemosiderin laden macrophages were seen commonly in this series; and may represent a histological marker in children. The disease is often self-limiting. Patients may require surgery for persistent nipple discharge or lump. CONCLUSIONS Duct ectasia should be entertained in small infants and children presenting with both small and large peri-areolar breast masses and/or bleeding. The occurrence of the disease in infants suggests that mammary duct ectasia may represent a developmental anomaly in the paediatric population.
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Affiliation(s)
- Merrill McHoney
- Department of Paediatric Surgery, Royal Hospital for Sick Children Edinburgh, United Kingdom.
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33
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Gallardo Muñoz I, Raya Povedano JL, Santos Romero AL. [Nodular pseudoangiomatous stromal hyperplasia of the breast in two adolescents]. RADIOLOGIA 2011; 54:549-52. [PMID: 21737108 DOI: 10.1016/j.rx.2010.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 09/03/2010] [Accepted: 09/13/2010] [Indexed: 11/24/2022]
Abstract
Nodular pseudoangiomatous stromal hyperplasia is a very rare benign breast lesion found in 0.4% of biopsies. It usually presents as a fast-growing palpable lesion in women between 30 and 40 years of age and is exceptionally rare in adolescents. Histological examination reveals a proliferation of stromal cells from connective tissue forming anastomosed empty pseudovascular spaces lined with myofibroblasts. We present the cases of two adolescents (13 and 18 years old) with fast-growing palpable breast nodules. Both underwent breast ultrasonography and core biopsy. The ultrasonographic findings of nodular pseudoangiomatous stromal hyperplasia were indistinguishable from those reported for juvenile fibroadenoma and for phyllodes tumor. Thus, histological study was required for the definitive diagnosis. Treatment depends on the size of the nodule. In our two patients, the lesion was surgically excised through tumorectomy and mastectomy.
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Affiliation(s)
- I Gallardo Muñoz
- Sección de Radiología de Mama, Hospital Reina Sofía, Córdoba, España.
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34
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de Chadarévian JP, Arthur LG, Rezvani GA, Duke DS, Davis WJ, Faerber EN. The galactocele of male infants: an intriguing entity. Study and reflection about a case, with review of the literature. Pediatr Dev Pathol 2011; 14:144-8. [PMID: 20718614 DOI: 10.2350/10-05-0827-cr.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this report, the authors investigate and discuss a galactocele that developed in the breast of a 5-month-old male. Based on the histological and immunohistochemical findings, they suggest that the rare and intriguing process that is exclusively observed in males in the absence of any detectable hormonal stimulation at time of investigation could represent a developmental anomaly possibly promoted by an obstructive phenomenon involving a defect of hollowing of some primary epidermal buds, the precursors of the mammary ducts.
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Affiliation(s)
- Jean-Pierre de Chadarévian
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
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35
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Köşüş N, Köşüş A, Duran M, Simavlı S, Turhan N. Comparison of standard mammography with digital mammography and digital infrared thermal imaging for breast cancer screening. J Turk Ger Gynecol Assoc 2010; 11:152-7. [PMID: 24591923 DOI: 10.5152/jtgga.2010.24] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 08/06/2010] [Indexed: 01/22/2023] Open
Abstract
Breast cancer is the most common malignancy in women. Screen-film mammography (SFM) has been considered the gold standard for breast cancer screening and detection. Despite its recognized value in detecting and characterizing breast disease, mammography has important limitations and its false-negative rate ranges from 4% to 34%. Given these limitations, development of imaging modalities that would enhance, complement, or replace mammography has been a priority. Digital mammography (FFDM) and digital infrared thermal imaging (DITI) are some of these alternative modalities.
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Affiliation(s)
- Nermin Köşüş
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Aydın Köşüş
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Müzeyyen Duran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Serap Simavlı
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Nilgün Turhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
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36
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Chung EM, Cube R, Hall GJ, González C, Stocker JT, Glassman LM. From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics 2009; 29:907-31. [PMID: 19448124 DOI: 10.1148/rg.293095010] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.
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Affiliation(s)
- Ellen M Chung
- Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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Kamal RM, Hamed ST, Salem DS. Classification of Inflammatory Breast Disorders and Step by Step Diagnosis. Breast J 2009; 15:367-80. [DOI: 10.1111/j.1524-4741.2009.00740.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Kristin L Cox
- Virginia Clinton Kelley/FFANY Breast Fellowship, Komen Interdisciplinary Breast Fellowship, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Fallat ME, Ignacio RC. Breast disorders in children and adolescents. J Pediatr Adolesc Gynecol 2008; 21:311-6. [PMID: 19064223 DOI: 10.1016/j.jpag.2007.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 10/08/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Mary E Fallat
- Department of Surgery, Division of Pediatric Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
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Role of Breast Sonography in Imaging of Adolescents with Palpable Solid Breast Masses. AJR Am J Roentgenol 2008; 191:659-63. [DOI: 10.2214/ajr.07.3390] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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41
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A worrisome, increasingly painful breast mass in an adolescent female. JAAPA 2008; 21:30, 32, 35. [DOI: 10.1097/01720610-200808000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Praeter C, De Coen K, Vanneste K, Vanhaesebrouck P. Unilateral bloody nipple discharge in a two-month-old male. Eur J Pediatr 2008; 167:457-9. [PMID: 17443348 DOI: 10.1007/s00431-007-0482-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 03/22/2007] [Indexed: 11/29/2022]
Abstract
Bloody nipple discharge is a rare but distressing finding in neonates and infants. We report on a 2-month-old boy with unilateral bloody nipple discharge. Ultrasound examination revealed dilated mammary ducts. This benign phenomenon is most likely to be caused by mammary ductal ectasia. Invasive investigations or surgery should be avoided in neonates or infants with bloody nipple discharge unless the discharge is unilateral, spontaneous, persistent and accompanied with a palpable mass. Otherwise only serial clinical follow-up is recommended until spontaneous resolution.
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Affiliation(s)
- Claudine De Praeter
- Department of Neonatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, Part 2: breast masses. J Pediatr Adolesc Gynecol 2006; 19:415-8. [PMID: 17174833 DOI: 10.1016/j.jpag.2006.09.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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44
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De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, Part 1: Disorders of growth and infections of the breast. J Pediatr Adolesc Gynecol 2006; 19:345-9. [PMID: 17060019 DOI: 10.1016/j.jpag.2006.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Nirupama K De Silva
- Obstetrics and Gynecology, Pediatric and Adolescent Gynecology, Associated Women's Specialists/OU-Tulsa, Tulsa, Oklahoma, USA.
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Bock K, Duda VF, Hadji P, Ramaswamy A, Schulz-Wendtland R, Klose KJ, Wagner U. Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1347-54; quiz 1356-7. [PMID: 16179617 DOI: 10.7863/jum.2005.24.10.1347] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The growing awareness of female breast cancer has led to increased sensitivity toward pathologic breast conditions in children and adolescents. Thus, approximately 15% of patients in child and adolescent gynecology are referred for the first time because of conspicuous features of the breast such as pain, palpable masses, and other findings on visual inspection. The aim of this study was to analyze the underlying diagnoses and diseases and determine the status of breast sonography in the diagnostic process. METHODS The study population consisted of 62 female patients between 8 weeks and 20 years of age (1997-2002) who were examined clinically, followed by standardized sonography (7.5-13 MHz, conventional B-mode panoramic sonography). Presumed diagnoses were confirmed by biopsy in some patients (n = 16) and by follow-up with clinical examination and sonography in most cases (n = 46). RESULTS The clinical and sonographic evaluation confirmed 4 main groups of diagnoses: benign tumors (15), developmental disturbances (14), cystic changes (11), and inherent defects (7). In the remaining cases, the findings were no abnormality (9), nipple discharge without evidence of pathologic or morphologic correlates (3), abscesses (2), and epidermoid cyst (1). CONCLUSIONS Knowledge of regular breast development and its variants is essential for the physician. Given knowledge of the sonographic appearance of physiologic breast development and specific lesions, breast sonography is most helpful in identifying and characterizing abnormalities and guiding further investigation.
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Affiliation(s)
- Karin Bock
- Medizinisches Zentrum für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg, Pilgrimstein 3, 35033 Marburg, Germany.
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Abstract
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.
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Affiliation(s)
- John A van Aalst
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, CD# 7195, Suite 2100, Bioinformatics Building, Chapel Hill, NC 27599, USA.
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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.
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Affiliation(s)
- Steven T Welch
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Gow KW, Mayfield JK, Lloyd D, Shehata BM. Pseudoangiomatous Stromal Hyperplasia of the Breast in Two Adolescent Females. Am Surg 2004. [DOI: 10.1177/000313480407000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The majority of breast lesions that present in adolescent girls are benign, with most being fibroadenomas. Rarely, a large and rapidly growing breast mass may be found to be the more recently described entity named pseudoangiomatous stromal hyperplasia (PASH). The pathogenesis of this lesion is attributed to hyperplasia of stromal myofibroblasts in response to hormonal stimuli. To date, PASH has rarely been described in adolescence. We describe the presentation of PASH in two adolescent patients. The first is a 12-year-old girl who found a mass in her left breast 3 months prior to presentation. An excision of an 11.5 x 10 x 3.5 cm lesion weighing 347 g was performed via breast-conserving incisions. The second patient is a 16-year-old girl who also had a rapidly enlarging left breast mass removed in a similar fashion. This mass measured 12 x 11 x 6 cm and weighed 460 g. Both tumors were noted to have a smooth capsule. Histologic appearance consisted of the typical features of PASH; fibrous stroma containing numerous anastomosing slit-like spaces; some compressed and others with discernible lumina. Both patients had complete excisions and have since not experienced recurrence. Each has had excellent cosmetic results with symmetrical breast development since their resection. Pseudoangiomatous stromal hyperplasia is a rare tumor that arises in the breast. These tumors may grow quickly and often are mistaken for fibroadenomas, phylloides tumor, or angiosarcoma. They must be resected with careful attention to resection around the capsule of the tumor with breast conservation as a goal. Long-term follow-up is necessary, as some have been reported to recur.
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Affiliation(s)
- Kenneth W. Gow
- Departments of Surgery, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - J. Kelly Mayfield
- Departments of Surgery, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - David Lloyd
- Departments of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Bahig M. Shehata
- Departments of Pathology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
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Abstract
This article reviews the recent medical literature on breast disorders in female adolescents. Most of the articles are reviews or case reports, because there is a paucity of primary research, particularly controlled prospective studies, in this area. The papers reviewed are clinically relevant, particularly in the evaluation of an adolescent with a breast mass. The information on early life factors (genetic and acquired) on subsequent risk for breast cancer later in life should be useful in our provision of anticipatory guidance to our adolescent patients regarding their breast cancer risk. The emerging literature on ethical issues raised by BRCA genetic screening is particularly important as we consider testing for our young patients.
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Affiliation(s)
- P S Simmons
- Mayo Clinic, Rochester, Minnesota 55095, USA.
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