Pediatric and Adolescent Breast Pathology

Pediatric and Adolescent Breast Pathology

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Summary

In pediatric patients, breast masses are relatively rare and – if they do occur – most are benign. The most common breast abnormality seen in children younger than 12 is a unilateral breast mass corresponding to asymmetrical breast development. Often, one breast develops earlier than the other, although they ultimately become symmetrical.

Expanded overview

In rare cases, congenital breast anomalies can occur. Athelia (absence of nipples) and amastia (absence of breast tissue) may occur bilaterally or unilaterally. This is a rare condition caused by mammary ridges that fail to develop or disappear.

An extra breast (polymastia) or extra nipple (polythelia) occurs in about 1 percent of the population, though extra nipples are slightly more common in males than in females. This extra tissue may cause discomfort during menstrual cycles and should be removed due to a risk of malignant transformation.

In pre-pubertal children, other breast infections and conditions may include:

  • Newborn breast enlargement  – caused by an influx of maternal hormones through the placenta – This disappears over time.
  • Infection of the breast tissue in newborns – mastitis neonatorum
  • Breast abscesses – commonly caused by the bacteria Staphylococcus aureus, this manifests as a tender, reddish mass
  • Benign premature thelarche – isolated breast development in young girls aged 6 months to 9 years
  • Precocious puberty – more common in girls, this is often idiopathic but may be a sign of an underlying condition

Adolescent girls may present with the following breast conditions:

  • Breast asymmetry
  • Breast abscesses, especially in lactating adolescents
  • Fibroadenomas – common, benign masses that are smooth, mobile, and round and may enlarge just before menstruation
  • Cystosarcoma phyllodes – less common, painless breast masses that can be quite large and may be benign (75%) or malignant (25%)
  • Breast hamartomas – rare, painless masses similar to fibroadenomas that can recur if not completely removed
  • Palpable mass from trauma – caused by breakdown of adipose tissue
  • Fibrocystic changes – discrete breast cysts or diffuse small lumps that are very common in the adolescent population – tenderness and heaviness may be felt before menstruation
  • Mammary duct ectasia – a benign lesion that consists of dilation of the mammary ducts, periductal fibrosis, and inflammation – often causing nipple discharge that may be bloody

Malignant breast disease is very rare in children and in adolescents. Risk factors for breast malignancies include:

  • History of familial breast cancer
  • Previous benign disease associated with malignancy (atypical  fibrocystic changes)
  • Other malignancies (that have metastasized)
  • Radiation delivered  to the neck and chest areas

Symptoms

If your child is experiencing any of the following breast symptoms, you should bring her in for examination by a doctor:

  • Breast enlargement in a pre-adolescent child
  • Swelling or redness of the breast tissue
  • Breast pain or tenderness not associated with menstruation
  • Nipple discharge
  • A palpable mass, or masses
  • A mass that appears after trauma to the breast
  • Early signs of puberty
  • Noticeably asymmetric breast development
  • Significant breast pain with menstruation

Tests and Diagnosis

If your daughter has a breast mass, the doctor will first ask about:

  • Family history of breast or ovarian malignancies
  • Family history of BRCA1 or BRCA2 mutations
  • If your child has had cancer
  • Previous radiation treatments of your child’s chest
  • History of trauma
  • History of other breast masses

Her doctor will then perform a complete examination of both breasts to evaluate for masses and nipple discharge.

Because breast tissue in young children is very dense, mammography is not usually very helpful for diagnosis. If your doctor cannot immediately diagnose the condition with physical examination, he or she may order an ultrasound test.

In young and pre-adolescent children, doctors avoid biopsy unless completely necessary, as it can harm the developing breast.

If your child is showing signs of early breast development, her doctor will examine her for other signs of puberty such as pubic hair and accelerated bone growth.

If your daughter’s doctor suspects precocious puberty, he or she will order blood hormone tests such as: luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), thyroxine (T4), testosterone, and estradiol.

Your doctor may want to monitor benign masses every few months to ensure they don’t enlarge, cause pain, or develop atypical changes.

Treatment

  • Amastia in girls can be treated with augmentation mammoplasty.
  • Mastitis neonatorum, infections of newborn breast tissue, can usually be treated with antibiotics.
  • If your pre-adolescent daughter has an abscess, her doctor will first treat her with antibiotics. In some cases, abscesses require surgical drainage.
  • Adolescent abscesses can be treated with antibiotics and/or ultrasound-guided drainage.
  • If your daughter is experiencing precocious puberty, her doctor may prescribe hormone-blocking medications delivered through injections or implants.
  • Some cystosarcoma phyllodes or hamartomas will require surgery if they are large or potentially malignant.
  • For fibrocystic changes, your daughter’s doctor will advise her to avoid caffeine and may suggest evening primrose oil to alleviate breast pain. Her doctor may want to perform a biopsy if one dominant lump is present for several months
  • Mammary duct ectasia is usually self-limited; therefore, surgery is not recommended if the diagnosis is certain.
  • If your daughter is diagnosed with a malignant mass in the breast, her doctor will treat her with surgery and chemotherapy.

FAQs

Could my child’s breast lump be cancerous?

In pediatric patients, breast masses are relatively rare and – if they do occur – most are benign. The most common breast abnormality seen in children younger than 12 is a unilateral breast mass corresponding to asymmetrical breast development. In adolescent girls, most masses are also benign.

What breast symptoms should prompt a doctor visit?

Bring your daughter in for an examination if she has a mass that’s painful or painless, redness, swelling, nipple discharge, pain, breast tenderness not associated with menstruation, or early breast development.

Resources

Adolescent & Young Adult / Gynecology

Phone:214-456-9099
Fax: 214-456-2230

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