Overview of breast masses in children and adolescents
- Chantay Banikarim, MD, MPH
Chantay Banikarim, MD, MPH
- Director of Adolescent Medicine
- St. Joseph's Hospital & Medical Center, Phoenix
- Nirupama K De Silva, MD
Nirupama K De Silva, MD
- Clinical Associate Professor
- University of Oklahoma-Tulsa
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
The overwhelming majority of breast masses in children and adolescents are benign and self-limited. Nonetheless, the finding of a breast mass can be disconcerting to the patient and her family [1,2].
The common causes of breast masses in children and adolescents and the approach to the evaluation of an adolescent with a breast mass will be discussed below. An overview of other breast disorders and breast infections in children and adolescents, and the evaluation of breast lumps in adult women, are presented separately. (See "Mastitis and breast abscess in infants, children, and adolescents" and "Breast disorders in children and adolescents: An overview" and "Clinical manifestations and diagnosis of a palpable breast mass".)
Assessment of breast masses in young females can be challenging due to normal glandular variance. Initial steps in evaluation of breast masses are obtaining a detailed history and physical examination . The breast examination in children and adolescents and self-breast examination in adolescents are discussed separately. (See "Breast disorders in children and adolescents: An overview", section on 'Breast examination'.)
CAUSES OF BREAST ENLARGEMENT IN CHILDREN
Neonates and infants — Breast hypertrophy related to stimulation from maternal hormones can occur in both male and female neonates during the first few weeks of life; it is sometimes associated with a thin milky nipple discharge ("witch's' milk") . Neonatal breast hypertrophy usually resolves spontaneously within two weeks in boys and several months in girls. However, it may persist if the breast tissue is stimulated (eg, by attempting to express the milky discharge).
Mastitis and/or breast abscess is another cause of breast enlargement in neonates. It is discussed separately. (See "Mastitis and breast abscess in infants, children, and adolescents".)
- Greydanus DE, Matytsina L, Gains M. Breast disorders in children and adolescents. Prim Care 2006; 33:455.
- De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, Part 2: breast masses. J Pediatr Adolesc Gynecol 2006; 19:415.
- Vargas HI, Vargas MP, Eldrageely K, et al. Outcomes of surgical and sonographic assessment of breast masses in women younger than 30. Am Surg 2005; 71:716.
- 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.
- West KW, Rescorla FJ, Scherer LR 3rd, Grosfeld JL. Diagnosis and treatment of symptomatic breast masses in the pediatric population. J Pediatr Surg 1995; 30:182.
- Bosman JM, Bax NM, Wit JM. Premature thelarche: a possible adverse effect of cimetidine treatment. Eur J Pediatr 1990; 149:534.
- Baren JM. Breast lesions. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams and Wilkins, Philadelphia 2006. p.193.
- Verrotti A, Ferrari M, Morgese G, Chiarelli F. Premature thelarche: a long-term follow-up. Gynecol Endocrinol 1996; 10:241.
- Templeman C, Hertweck SP. Breast disorders in the pediatric and adolescent patient. Obstet Gynecol Clin North Am 2000; 27:19.
- Bock K, Duda VF, Hadji P, et al. Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis. J Ultrasound Med 2005; 24:1347.
- ACOG Committee on Adolescent Health Care. ACOG Committee Opinion No. 350, November 2006: Breast concerns in the adolescent. Obstet Gynecol 2006; 108:1329.
- Schairer C, Brinton LA, Hoover RN. Methylxanthines and benign breast disease. Am J Epidemiol 1986; 124:603.
- Levinson W, Dunn PM. Nonassociation of caffeine and fibrocystic breast disease. Arch Intern Med 1986; 146:1773.
- Jacobson MF, Liebman BF. Caffeine and benign breast disease. JAMA 1986; 255:1438.
- DiVasta AD, Weldon C, Labow BI. The breast: Examination and lesions. In: Emans, Laufer, Goldstein's Pediatric & Adolescent Gynecology, 6th, Emans SJ, Laufer MR. (Eds), Lippincott Williams & Wilkins, Philadelphia 2012. p.405.
- Gumm R, Cunnick GH, Mokbel K. Evidence for the management of mastalgia. Curr Med Res Opin 2004; 20:681.
- Pye JK, Mansel RE, Hughes LE. Clinical experience of drug treatments for mastalgia. Lancet 1985; 2:373.
- Faiz O, Fentiman IS. Management of breast pain. Int J Clin Pract 2000; 54:228.
- Fornage BD, Lorigan JG, Andry E. Fibroadenoma of the breast: sonographic appearance. Radiology 1989; 172:671.
- Jayasinghe Y, Simmons PS. Fibroadenomas in adolescence. Curr Opin Obstet Gynecol 2009; 21:402.
- Smith GE, Burrows P. Ultrasound diagnosis of fibroadenoma - is biopsy always necessary? Clin Radiol 2008; 63:511.
- Tea MK, Asseryanis E, Kroiss R, et al. Surgical breast lesions in adolescent females. Pediatr Surg Int 2009; 25:73.
- Chao TC, Lo YF, Chen SC, Chen MF. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol 2002; 20:64.
- Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J 2001; 77:428.
- Alabassi A, Fentiman IS. Sarcomas of the breast. Int J Clin Pract 2003; 57:886.
- Pistolese CA, Tanga I, Cossu E, et al. A phyllodes tumor in a child. J Pediatr Adolesc Gynecol 2009; 22:e21.
- Reinfuss M, Mituś J, Duda K, et al. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer 1996; 77:910.
- Oberman HA, Stephens PJ. Carcinoma of the breast in childhood. Cancer 1972; 30:470.
- Neinstein LS. Review of breast masses in adolescents. Adolesc Pediatr Gynecol 1994; 7:119.
- Schwartz GF. Benign neoplasms and "inflammations" of the breast. Clin Obstet Gynecol 1982; 25:373.
- García CJ, Espinoza A, Dinamarca V, et al. Breast US in children and adolescents. Radiographics 2000; 20:1605.
- Huneeus A, Schilling A, Horvath E, et al. Retroareolar cysts in the adolescent. J Pediatr Adolesc Gynecol 2003; 16:45.
- Watkins F, Giacomantonio M, Salisbury S. Nipple discharge and breast lump related to Montgomery's tubercles in adolescent females. J Pediatr Surg 1988; 23:718.
- Williams HJ, Hejmadi RK, England DW, Bradley SA. Imaging features of breast trauma: a pictorial review. Breast 2002; 11:107.
- Corpron CA, Black CT, Singletary SE, Andrassy RJ. Breast cancer in adolescent females. J Pediatr Surg 1995; 30:322.
- Bhatia S, Robison LL, Oberlin O, et al. Breast cancer and other second neoplasms after childhood Hodgkin's disease. N Engl J Med 1996; 334:745.
- Dixon JM, Mansel RE. ABC of breast diseases. Congenital problems and aberrations of normal breast development and involution. BMJ 1994; 309:797.
- Ravichandran D, Naz S. A study of children and adolescents referred to a rapid diagnosis breast clinic. Eur J Pediatr Surg 2006; 16:303.
- Longo OA, Mosto A, Moran JC, et al. Breast Carcinoma in Childhood and Adolescence: Case Report and Review of the Literature. Breast J 1999; 5:65.
- Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD. Available at: http://seer.cancer.gov/csr/1975_2011/ (Accessed on August 25, 2014).
- Binokay F, Soyupak SK, Inal M, et al. Primary and metastatic rhabdomyosarcoma in the breast: report of two pediatric cases. Eur J Radiol 2003; 48:282.
- Marchant DJ. History, physical examination, and breast self-examination. Clin Obstet Gynecol 1982; 25:359.
- Wile AG, Kollin M. Office management of the breast mass. Postgrad Med 1987; 81:137.
- Hammar B. Childhood breast carcinoma: report of a case. J Pediatr Surg 1981; 16:77.
- Rogers DA, Lobe TE, Rao BN, et al. Breast malignancy in children. J Pediatr Surg 1994; 29:48.
- Chateil JF, Arboucalot F, Pérel Y, et al. Breast metastases in adolescent girls: US findings. Pediatr Radiol 1998; 28:832.
- Howarth CB, Caces JN, Pratt CB. Breast metastases in children with rhabdomyosarcoma. Cancer 1980; 46:2520.
- Chung EM, Cube R, Hall GJ, et al. From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics 2009; 29:907.
- Pappo AS, Rodriguez-Galindo C, Furman WL. Management of infrequent cancers of childhood. In: Principles and Practice of Pediatric Oncology, 6th ed, Pizzo PA, Poplack DG (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.1098.
- Raj KA, Marks LB, Prosnitz RG. Late effects of breast radiotherapy in young women. Breast Dis 2005-2006; 23:53.
- Carty NJ, Carter C, Rubin C, et al. Management of fibroadenoma of the breast. Ann R Coll Surg Engl 1995; 77:127.
- Kaneda HJ, Mack J, Kasales CJ, Schetter S. Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment. AJR Am J Roentgenol 2013; 200:W204.
- Sickles EA, Filly RA, Callen PW. Benign breast lesions: ultrasound detection and diagnosis. Radiology 1984; 151:467.
- Egan RL, Egan KL. Automated water-path full-breast sonography: correlation with histology of 176 solid lesions. AJR Am J Roentgenol 1984; 143:499.
- Hilton SV, Leopold GR, Olson LK, Willson SA. Real-time breast sonography: application in 300 consecutive patients. AJR Am J Roentgenol 1986; 147:479.
- Jellins J, Kossoff G, Reeve TS. Detection and classification of liquid-filled masses in the breast by gray scale echography. Radiology 1977; 125:205.
- Hindle WH, Arias RD, Florentine B, Whang J. Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts. Am J Obstet Gynecol 2000; 182:1300.
- BREAST EXAMINATION
- CAUSES OF BREAST ENLARGEMENT IN CHILDREN
- Neonates and infants
- Prepubertal and pubertal children
- BREAST ENLARGEMENT IN ADOLESCENT MALES
- CAUSES OF BREAST MASS IN FEMALE ADOLESCENTS
- Fibrocystic change
- - Giant fibroadenoma
- Phyllodes tumor
- Intraductal papilloma
- Mammary duct ectasia
- Montgomery tubercles
- Breast trauma
- Breast infection
- Primary breast cancer
- - Risk factors
- Metastatic cancer
- Secondary cancer
- APPROACH TO BREAST MASS IN THE FEMALE ADOLESCENT PATIENT
- Subsequent management