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BREAST MASSES IN CHILDREN AND ADOLESCENTS

BREAST MASSES IN CHILDREN AND ADOLESCENTS. BREAST MASSES. The majority of the breast masses in children and adolescents are benign and self limited. The finding of a breast mass is very disconcerting to the patient and her family. . CAUSES. NEONATES

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BREAST MASSES IN CHILDREN AND ADOLESCENTS

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  1. BREAST MASSESIN CHILDREN AND ADOLESCENTS

  2. BREAST MASSES • The majority of the breast masses in children and adolescents are benign and self limited. • The finding of a breast mass is very disconcerting to the patient and her family.

  3. CAUSES • NEONATES • Breast hypertrophy due to stimulation from maternal hormones. • Occurs in both males and females. • Sometimes associated with a milky discharge (witch’s milk). • Resolves spontaneously within 2,weeks in boys and several months in girls. • Mastitis or breast abscess.

  4. CAUSES IN PREPUBERTAL AND PUBERTAL CHILDREN • Usually breast buds. • In pubertal children is usually the first sign of puberty. • In prepubertal children may indicate premature thelarche or precocious puberty. • Hemangiomas and lymphangiomas,dx. Clinically.

  5. CAUSES IN ADOLESCENTS • Usually self limited and benign. • Fibrocystic disease • Fibroadenoma • Breast trauma • Breast infection

  6. FIBROCYSTIC DISEASE • More common in adolescents • Cause is not known • Maybe an imbalance between estrogen and progestrone • Caffeine may worsen the symptoms • Painful breast tissue before menstruation • Generally in the upper outer quadrants • Green or brown discharge maybe present

  7. Fibrocystic disease cont. • TREATMENT • Analgesia • Oral contraceptives • Elemination of caffeine

  8. FIBROADENOMA • Most common breast lesion in adolescent • Rubbery,well circumscribed and mobile • Usually 2-3 cm • Found in the upper and outer quadrants but may occur any quadrant. • Recurrent or multiple in 10-25% of cases.

  9. FIBROADENOMA CONT • Dx. Clinically • Ultrasonography or needle aspiration maybe used. • A solid well circumscribed avascular mass in the u/s. • Mammography is not indicated in adolescents,since the large amount of glandular tissue is difficult to interpret.

  10. FIBROADENOMA CONT • All lesions less than 5 cm can be safely observed with serial examination • If there is growth in the lesion, size is > 5cm or persists to adulthood, excisional biopsy is warranted.

  11. GIANT FIBROADENOMA • Grow rapidly to >5cm. • May compress normal breast tissue • Should be excised. • Cannot be distinguished from phyllodes tumors by P.E. Ultrasonography or mammography.

  12. PHYLLODES TUMOR • Rare primary tumor • Occurs in older women • Has been reported in girls as young as 10 years • Diverse range of behavior • Usually presents as a large painless breast mass • Bloody discharge maybe present • Recommended treatment is excision • Radical measures if malignant

  13. INTRADUCTAL PAPILLOMA • Rare benign tumor • From the proliferation of mammary duct epithelium • Presents clinically as bloody discharge or breast enlargement • Maybe bilateral • Well circumscribed nodules palpated under the areola or in the periphery of the breast • Treated by excision

  14. MAMMARY DUCT ECTASIA • Distention of subareolar ducts with fibrosis and inflammation • Multicolored sticky discharge. • May appear as a blue mass under the nipple if the fluid in the cyst is dark in color • Excision is diagnostic and is curative

  15. MONTGOMERY TUBERCLES • Small tubercles at the edge of the areola • Obstruction may lead to acute inflammation • Dx. Clinically. • Cysts are observed with serial examination and ultrasonography. • Over 80% resolve in weeks to months,may take upto 2,years.

  16. BREAST TRAUMA • Direct blow may cause fat necrosis • This can resemble a solid mass. • Clinically and radiographically fat necrosis can mimic malignancy.

  17. PRIMARY BREAST CANCER • Rare in children and adolescents. • Juvenile secretory carcinoma is most common. • Followed by intraductal carcinoma. Rhabdomyosarcoma and lymphoma can also occur as a primary lesion

  18. CANCER CONT • The most common finding is a hard irregular mass. • May or may not be fixed. • Skin or nipple retraction. • Skin edema (peau d’orange) • Nipple involvement and nipple discharge. • Axillary and supraclavicular lymphadenopathy.

  19. HISTORY important aspects • Duration • Associated symptoms • Previous breast disease • Previous or present malignancy or hx.of irradiation • Chronology of the development of secondary sexual characters • Menstrual history • Pregnancy • Medication • Family history

  20. EXAMINATION-important aspects • Location • Consistency • Size • Mobility • Tenderness • Overlying skin changes • Nipple discharge • Appearance of the nipple • Lymphadenopathy • hepatosplenomegaly

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