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 • 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.
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.
CAUSES IN ADOLESCENTS • Usually self limited and benign. • Fibrocystic disease • Fibroadenoma • Breast trauma • Breast infection
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
Fibrocystic disease cont. • TREATMENT • Analgesia • Oral contraceptives • Elemination of caffeine
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.
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.
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.
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.
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
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
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
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.
BREAST TRAUMA • Direct blow may cause fat necrosis • This can resemble a solid mass. • Clinically and radiographically fat necrosis can mimic malignancy.
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
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.
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
EXAMINATION-important aspects • Location • Consistency • Size • Mobility • Tenderness • Overlying skin changes • Nipple discharge • Appearance of the nipple • Lymphadenopathy • hepatosplenomegaly