Breast Masses in Children and Adolescents: Radiologic-Pathologic Correlation

Abstract

The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.

Phyllodes Tumor of the Breast: Analysis of 48 Patients

“…The sonographic and mammographic findings were parallel to the literature; no specific radiologic feature was identified to differentiate the histologic subtypes of PTs. In addition, FA was the most commonly reported radiologic diagnosis with both US and MG, consistent with previous works (15)(16)(17). In recent years, several studies regarding the potential role of magnetic resonance imaging (MRI) in the diagnosis of PT have been published.…”

Breast diseases in children: the spectrum of radiologic findings in a cohort study

“…Sixty-five percent of all solid masses were fibroadenomas or fibroadenoma-like lesions (probably benign solid masses), mostly in adolescents, similar to the findings reported by other investigators (2,8). Notably, we did not detect any solid masses in patients <8 years of age.…”

“…Gynecomastia may occur in neonatal or pubertal period while it is most commonly encountered in adolescence (2,5,6,17). However, in our study, gynecomastia, generally bilateral, was detected mostly in the 8-15 years age group, one or two years after the onset of puberty.…”

“…Findings were considered "normal" in case of: a) no remarkable US findings in males, b) no remarkable US findings in girls <8 years of age, and c) only fibroglandular tissue in girls >8 years of age (peripubertal and adolescents girls). We did not use the US findings compatible with the stage of thelarche adopted from Tanner's classification, since this kind of evaluation would not contribute to our purpose (2,5,6).…”

Ewing sarcoma metastasis to breast

“…Both primary and secondary malignant breast lesions are rare in children. The most common primary breast malignancies are malignant phyllodes tumors (1).…”