Pediatric Annals

case challenges: radiology 

A 13-year-old Girl With a Breast Mass

Ellen C Benya, MD

Abstract

DIAGNOSIS

Juvenile fibroadenoma

DISCUSSION

Breast masses in children and adolescents almost always represent benign lesions such as cysts, abscesses, fibroadenomas, or hematomas and are rarely due to malignant lesions such as a phyllodes tumor or métastases from rhabdomyosarcoma, leukemia, lymphoma, or neuroblastoma.1'2 The recommended imaging modality for girls with breast masses is ultrasound examination, which will confirm the presence of a mass and allow characterization of the mass as cystic or solid. There is no role for mammography in girls because of the very low likelihood of breast carcinoma, the limited image quality in young girls who have dense, predominantly fibroglandular breast tissue, and concern regarding the effects of radiation exposure to the developing breast.1'2

Ultrasound assessment of the breast lesion with gray scale and color Doppler will determine whether the lesion is a simple cyst (frequently retroareolar in location), a complicated cystic lesion such as an abscess or hematoma, or a solid soft tissue lesion. Fibroadenomas, the most common solid breast lesion in girls, typically are well-circumscribed ovoid lesions hypoechoic to the adjacent breast tissue with posterior acoustic transmission.1'3 Color Doppler assessment may detect internal blood flow, although some fibroadenomas are avascular or hypovascular.1

1. Garcia CJ, Espìnoza A, Dinamarca V, et al. Breast US in children and adolescents. Radiographies. 2000;20(6):1605-1612.

2. Chateil JF, Arboucalot F, Perel Y, et al. Breast métastases in adolescent girls: US findings. Pediatr Radial. 1998;28(11): 832-835.

3. Kronemer KA, Rhee K, Siegel MJ, Sievert L, Hildebolt C. Gray scale sonography of breast masses in adolescent girls. J Ultrasound Med. 2001;20(5): 491496.…

Figure 1a (above). Split screen image reveals the normal echotexture of the right breast, with a rounded hypoechoic mass (arrows) in the left breast.

Figure 1a (above). Split screen image reveals the normal echotexture of the right breast, with a rounded hypoechoic mass (arrows) in the left breast.

A 13-year-old girl presented complaining of asymmetric breast size, with the left breast larger than the right. She was otherwise healthy with no fever, nipple discharge, or breast tenderness or erythema. On physical examination, her left breast was larger than the right, with a firm, mobile mass palpated. Her physical examination was otherwise normal.

Her primary pediatrician referred her for a breast ultrasound (Figure 1), which revealed an ovoid hypoechoic mass in the left breast with posterior acoustic through transmission. On color and spectral Doppler assessment, blood flow was detected within the lesion confirming the presence of a solid soft tissue mass. The mass was surgically excised without complication.

Figure 1b (left). Ultrasound image of the left breast with Doppler assessment reveals blood flow within the mass confirming the presence of a solid soft tissue lesion.

Figure 1b (left). Ultrasound image of the left breast with Doppler assessment reveals blood flow within the mass confirming the presence of a solid soft tissue lesion.

DIAGNOSIS

Juvenile fibroadenoma

DISCUSSION

Breast masses in children and adolescents almost always represent benign lesions such as cysts, abscesses, fibroadenomas, or hematomas and are rarely due to malignant lesions such as a phyllodes tumor or métastases from rhabdomyosarcoma, leukemia, lymphoma, or neuroblastoma.1'2 The recommended imaging modality for girls with breast masses is ultrasound examination, which will confirm the presence of a mass and allow characterization of the mass as cystic or solid. There is no role for mammography in girls because of the very low likelihood of breast carcinoma, the limited image quality in young girls who have dense, predominantly fibroglandular breast tissue, and concern regarding the effects of radiation exposure to the developing breast.1'2

Ultrasound assessment of the breast lesion with gray scale and color Doppler will determine whether the lesion is a simple cyst (frequently retroareolar in location), a complicated cystic lesion such as an abscess or hematoma, or a solid soft tissue lesion. Fibroadenomas, the most common solid breast lesion in girls, typically are well-circumscribed ovoid lesions hypoechoic to the adjacent breast tissue with posterior acoustic transmission.1'3 Color Doppler assessment may detect internal blood flow, although some fibroadenomas are avascular or hypovascular.1

REFERENCES

1. Garcia CJ, Espìnoza A, Dinamarca V, et al. Breast US in children and adolescents. Radiographies. 2000;20(6):1605-1612.

2. Chateil JF, Arboucalot F, Perel Y, et al. Breast métastases in adolescent girls: US findings. Pediatr Radial. 1998;28(11): 832-835.

3. Kronemer KA, Rhee K, Siegel MJ, Sievert L, Hildebolt C. Gray scale sonography of breast masses in adolescent girls. J Ultrasound Med. 2001;20(5): 491496.

10.3928/0090-4481-20051201-07

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