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Zhang M, Arjmandi FK, Porembka JH, Seiler SJ, Goudreau SH, Merchant K, Hwang H, Hayes JC. Imaging and Management of Fibroepithelial Lesions of the Breast: Radiologic-Pathologic Correlation. Radiographics 2023; 43:e230051. [PMID: 37856317 DOI: 10.1148/rg.230051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Fibroepithelial lesions (FELs) are among the most common breast masses encountered by breast radiologists and pathologists. They encompass a spectrum of benign and malignant lesions, including fibroadenomas (FAs) and phyllodes tumors (PTs). FAs are typically seen in young premenopausal women, with a peak incidence at 20-30 years of age, and have imaging features of oval circumscribed hypoechoic masses. Although some FA variants are especially sensitive to hormonal influences and can exhibit rapid growth (eg, juvenile FA and lactational adenomas), most simple FAs are slow growing and involute after menopause. PTs can be benign, borderline, or malignant and are more common in older women aged 40-50 years. PTs usually manifest as enlarging palpable masses and are associated with a larger size and sometimes with an irregular shape at imaging compared with FAs. Although FA and FA variants are typically managed conservatively unless large and symptomatic, PTs are surgically excised because of the risk of undersampling at percutaneous biopsy and the malignant potential of borderline and malignant PTs. As a result of the overlap in imaging and histologic appearances, FELs can present a diagnostic challenge for the radiologist and pathologist. Radiologists can facilitate accurate diagnosis by supplying adequate tissue sampling and including critical information for the pathologist at the time of biopsy. Understanding the spectrum of FELs can facilitate and guide appropriate radiologic-pathologic correlation and timely diagnosis and management of PTs. Published under a CC BY 4.0 license. Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Meng Zhang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Firouzeh K Arjmandi
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jessica H Porembka
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Stephen J Seiler
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Sally H Goudreau
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Kanwal Merchant
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Helena Hwang
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
| | - Jody C Hayes
- From the Departments of Radiology (M.Z., F.K.A., J.H.P., S.J.S., S.H.G., K.M., J.C.H.) and Pathology (H.H.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8896, Dallas, TX 75390-8896
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2
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Sornlertlumvanich M, Rohitopakarn P, Samphao S, Pradaranon V, Kaewpiboon W, Kietsiriroje N, Danglaoun S. Repeated recurrence of bilateral gigantomastia after subcutaneous mastectomy caused by tumoral pseudoangiomatous stromal hyperplasia: a case report and review of literature. BJR Case Rep 2023; 9:20220074. [PMID: 36873230 PMCID: PMC9976717 DOI: 10.1259/bjrcr.20220074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023] Open
Abstract
Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign proliferative mesenchymal lesion of the breast with a hormonal-sensitive nature. Various manifestations of PASH, ranging from an incidental microscopic finding in a tissue biopsy to a large palpable mass or bilateral gigantomastia, have been described. For tumoral PASH, surgical excision is indicated for a growing and symptomatic mass with a small chance of recurrence. A recurrence of bilateral gigantomastia after surgical excision or reduction mammoplasty is not common but has been occasionally reported, leading to further mastectomy. Repeated recurrence of bilateral gigantomastia is extremely rare. Herein, we report a case of a 13-year-old girl who presented with the third recurrence of bilateral gigantomastia caused by tumoral PASH, after undergoing bilateral reduction mammoplasty, and later subcutaneous mastectomy. Precocious puberty occurred early in this child at the age of 9 years, which may have been a factor unmasking PASH at this young age. The incomplete removal of the PASH could also have been a recurrence risk in our case as extended masses underneath the pectoralis muscle were later identified on the MRI study. This highlights the advantage of preoperative imaging in cases with a very large tumoral PASH in order to maximize the chance of complete tumor removal.
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Affiliation(s)
| | - Patteera Rohitopakarn
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Srila Samphao
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Varanatjaa Pradaranon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Warunee Kaewpiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Noppadol Kietsiriroje
- Endocrinology and Metabolism Unit, Department of Internal medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Siriorn Danglaoun
- Department of Anatomical Pathology, Lampang hospital, Lampang, Thailand
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3
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Adekeye A, Lung KC, Brill KL. Pediatric and Adolescent Breast Conditions: A Review. J Pediatr Adolesc Gynecol 2023; 36:5-13. [PMID: 36356839 DOI: 10.1016/j.jpag.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/14/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Breast conditions in pediatric and adolescent patients vary from benign congenital changes to pathological findings. Although most breast conditions are benign, there are rare cases of malignancy that are important to identify during development. As such, it is critical to understand the classification and management of the different pediatric and adolescent breast conditions that might present to clinicians who care for pediatric and adolescent patients. In this review, congenital, benign, and malignant pediatric/adolescent breast conditions are discussed.
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Affiliation(s)
- Adeseye Adekeye
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Kirsten C Lung
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristin L Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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4
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Burt E, Ruff C, Yasmin E, Davies M, Cameron-Pimblett A, Butler G, Conway G. Challenges in developing a quantitative method of measuring breast development using 3D imaging: An example of a novel method for use in induced breast development with exogenous oestrogen. Clin Endocrinol (Oxf) 2023; 98:68-73. [PMID: 35978390 DOI: 10.1111/cen.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Optimal breast development is an essential part of exogenous oestrogen treatment in females undergoing pubertal induction. We set out to develop a novel technique using three-dimensional (3D) imaging to determine change in breast volume that is applicable when no pre-existing breast contours are present. DESIGN A prospective observational study. PATIENTS The imaging methodology was developed using a single male subject to assess reproducibility and validity. The technique was then applied to 29 participants undergoing pubertal induction with exogenous oestradiol who were recruited from Paediatric Gynaecology and Reproductive Endocrinology clinics at University College London Hospital. MEASUREMENTS Breast images were taken using a 3D photographic system. Two images, taken at different times, were manually superimposed to produce a differential breast volume. The initial step of method development set out to show that volume change was not secondary to positioning artefact or image manipulation. This was established by using images of a male participant taken on different occasions. The technique was then used to assess reproducibility in participants undergoing pubertal induction treatment. RESULTS Good intraobserver reproducibility (intraclass correlation (ICC) 0.77) was demonstrated with static image manipulation. Validity of the imaging technique was established as there was no significant difference between the known reference volume produced by computer generated warping and that calculated by manual image manipulation. There was excellent intraobserver reproducibility for breast volume calculation in participants undergoing induced breast development (ICC 0.99). CONCLUSIONS 3D imaging is a promising novel tool to provide quantitative breast volume assessment in individuals undergoing breast induction with exogenous oestradiol treatment.
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Affiliation(s)
- Elizabeth Burt
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Clifford Ruff
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Melanie Davies
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | | | - Gary Butler
- Department of Paediatric Endocrinology, University College London Hospitals, London, UK
| | - Gerard Conway
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
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Phadke S, Sogani J, Parikh AK, Ndibe CC, Alazraki AL, Linam LE, Riedesel EL. Imaging of the Pediatric Breast: Review of Normal Development and Spectrum of Disease. Radiographics 2023; 43:e220047. [DOI: 10.1148/rg.220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harper LK, Simmons CL, Woodard GA, Solanki MH, Bhatt AA. Pictorial Review of Common and Uncommon Pediatric Breast Lesions. Radiographics 2023; 43:e220117. [DOI: 10.1148/rg.220117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura K. Harper
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Curtis L. Simmons
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Genevieve A. Woodard
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Malvika H. Solanki
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
| | - Asha A. Bhatt
- From the Department of Radiology, Mayo Clinic, 5881 E Mayo Blvd, PX CB 01 RADGLY, Phoenix, AZ 85054 (L.K.H.); Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (C.L.S.); and Departments of Radiology (G.A.W., A.A.B.) and Pathology (M.H.S.), Mayo Clinic, Rochester, Minn
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7
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Hudson-Phillips S, Graham G, Cox K, Al Sarakbi W. Fibroadenoma: a guide for junior clinicians. Br J Hosp Med (Lond) 2022; 83:1-9. [PMID: 36322437 DOI: 10.12968/hmed.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Fibroadenoma is the most common cause of benign breast lumps and is typically seen in women under the age of 40 years. Fibroadenomas are classified as simple, complex, giant, myxoid or juvenile. They present as smooth, rubbery, mobile masses on palpation. Ultrasonographic and mammographic features typical of fibroadenomas include solid, round, well-circumscribed masses, with or without lobulated features. They are predominantly treated conservatively although clinical pathways recommend referral for triple assessment. Surgical intervention is indicated by the presence of one or more of the following features: the presence of symptoms, a diameter greater than 2 cm, rapid growth rate, complex features, disease recurrence or patient anxiety.
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Affiliation(s)
| | - Gemma Graham
- Department of General Surgery, Epsom and St Helier Hospital, London, UK
| | - Kofi Cox
- Department of Medicine, St George's University of London, London, UK
| | - Wail Al Sarakbi
- Department of Oncoplastic Breast Surgery, Croydon University Hospital, London, UK
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8
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Nguyen DL, Ambinder EB, Mullen LA, Oluyemi ET, Dunn EA. Comparison of emergency pediatric breast ultrasound interpretations and management recommendations between pediatric radiologists and breast imaging radiologists. Emerg Radiol 2022; 29:987-993. [PMID: 35971026 DOI: 10.1007/s10140-022-02081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Pediatric patients with breast-related symptoms often initially present to the emergency department for evaluation. While pediatric radiologists are accustomed to evaluating acute infectious and traumatic etiologies, they may be less familiar with breast-specific findings. This study compares management recommendations of pediatric breast ultrasounds performed in the emergency setting between pediatric and breast imaging radiologists. METHODS This retrospective cohort study reviewed data from all pediatric breast ultrasounds performed in the emergency setting from a single academic institution from 1/1/14 to 12/31/19. During the study period, 12 pediatric radiologists with experience ranging from 1 to 33 years interpreted pediatric breast ultrasounds. Three breast imaging radiologists (with 3, 8, and 25 years of experience) retrospectively reviewed each case and recorded whether further management was recommended. Differences in recommendations were compared using Fisher's exact test. Cohen's kappa was used to assess agreement between subspecialty radiologists. RESULTS This study included 75 pediatric patients, with mean age 13 ± 5.6 years and malignancy rate of 1.3% (1/75). Pediatric radiologists and the most experienced breast imaging radiologist had moderate agreement in management recommendations (k = 0.54). There was no significant difference in recommendations for further management between pediatric radiologists (22/75 [29.3%]) and the most experienced breast imaging radiologist (15/75 [20.0%]), p = 0.26. CONCLUSION Recommendations for pediatric breast complaints in the emergency setting are comparable between subspecialties.
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Affiliation(s)
- Derek L Nguyen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Emily B Ambinder
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eniola T Oluyemi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Emily A Dunn
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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9
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Breast Sarcoma Incidence Rate: A National Study in Iran. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-120247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Breast sarcomas are a group of rare and non-epithelial malignancies that account for less than 1% of breast cancers. There are few epidemiologic studies on this type of cancer due to its rarity. Methods: In this study, the database of the Iran National Cancer Registry (INCR) from March 2009 to March 2014 was used to calculate the age-specific incidence rate for breast sarcoma in Iran. Moreover, age-standardized incidence rate (ASR) for pathologic subtypes, pathologic grades, and different regions of the country were determined. Results: Totally, 258 breast sarcoma patients were included in this study in Iran. The ASR of breast sarcoma was 1.17 (95% CI: 1.02, .32) and 0.60 (95% CI: 0.52, 0.67) per million person-years for women and the total population, respectively. ASR was 0.03 (95%CI: 0.01, 0.06) per million person-years for male patients. The highest age-specific incidence rate for malignant phyllodes was observed among patients aged 55 to 59 years (1.0; 95% CI: 0.5, 1.5), and for other sarcomas, it was found among those aged 70 to 74 years (0.9; 95% CI: 0.2, 1.6). The most prevalent pathologic grade of sarcoma was grade 3 with an ASR of 0.40 (95% CI: 0.34, 0.46) per million person-years. Conclusions: Compared to western countries, Iran has a lower incidence of breast sarcoma in women, a higher incidence rate in men, and older onset age. As in other countries, malignant phyllodes tumors and angiosarcomas are the most common subtypes. In addition, breast sarcoma incidence rates in different grades are similar across countries.
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10
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Navarro SM, Shaikh H, Abdi H, Keil EJ, Odusanya S, Stewart KA, Tuyishime E, Mazingi D, Tuttle TM. Surgical applications of ultrasound use in low‐ and
middle‐income
countries: A systematic review. Australas J Ultrasound Med 2022; 25:80-97. [DOI: 10.1002/ajum.12302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Sergio M. Navarro
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Hashim Shaikh
- Department of Orthopaedics University of Rochester 601 Elmwood Avenue Rochester NY 14642 USA
| | - Hodan Abdi
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Evan J. Keil
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Simisola Odusanya
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Kelsey A. Stewart
- Department of Anaesthesia, Critical Care, and Emergency Medicine University of Rwanda KN 4 Ave Kigali Rwanda
| | - Eugene Tuyishime
- Department of Anaesthesia University of Toronto 123 Edward Street Toronto ON M5G 1E2 Canada
- Department of Obstetrics and Gyenecology University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Dennis Mazingi
- Department of Surgery University of Zimbabwe Mazowe Street A168 Harare Zimbabwe
| | - Todd M. Tuttle
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
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11
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Yang S, Leng Y, Chau CM, Ma KFJ, Fung WY, Chan RLS, Yung WTA, Leong PW, Li OCA, Wong T. The ins and outs of male breast and anterior chest wall lesions from childhood to adulthood. Clin Radiol 2022; 77:503-513. [PMID: 35365295 DOI: 10.1016/j.crad.2022.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022]
Abstract
Physiological and pathological processes arising from the breast and anterior chest wall may share similar clinical presentations because of the small volume of male breasts. Therefore, imaging is frequently required to localise and characterise the lesion and guide biopsy when radiological findings are equivocal or suspicious. Mammography or digital breast tomosynthesis (DBT) and ultrasound are the mainstays of breast imaging work-up. Other imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron-emission tomography (PET) can sometimes augment the investigation and aid treatment planning. This article reviews the key imaging features of a wide spectrum of benign and malignant conditions that involve the male breast and anterior chest wall across various age groups. Familiarisation with the salient radiological findings is essential for reaching an accurate diagnosis and optimising management.
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Affiliation(s)
- S Yang
- Department of Radiology, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, N.T, Hong Kong; Department of Radiology, Pok Oi Hospital, Au Tau, Yuen Long, N.T, Hong Kong.
| | - Y Leng
- Department of Radiology, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, N.T, Hong Kong; Department of Radiology, Pok Oi Hospital, Au Tau, Yuen Long, N.T, Hong Kong
| | - C M Chau
- Department of Radiology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - K F J Ma
- Department of Radiology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - W Y Fung
- Department of Radiology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - R L S Chan
- Department of Radiology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - W T A Yung
- Department of Radiology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - P W Leong
- Department of Radiology, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, N.T, Hong Kong; Department of Radiology, Pok Oi Hospital, Au Tau, Yuen Long, N.T, Hong Kong
| | - O C A Li
- Department of Radiology, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, N.T, Hong Kong; Department of Radiology, Pok Oi Hospital, Au Tau, Yuen Long, N.T, Hong Kong
| | - T Wong
- Department of Radiology, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
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12
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Belkouchi L, El Haddad S, Mrani Alaoui N, Allali N, Chat L. Child gigantomastia revealing juvenile giant fibroadenomas. BJR Case Rep 2022; 8:20210181. [PMID: 36177259 PMCID: PMC9499430 DOI: 10.1259/bjrcr.20210181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Breast masses in children and adolescents are uncommon. They can be caused by tumors such as fibroadenomas and phyllode tumors. These masses can cause gigantomastia, due to their rapidly increasing size. We report the case of a 12- year-old patient admitted in our department for a rapidly growing gigantomastia evolving in a matter of 8 months. Imaging features were in favor of juvenile giant fibroadenomas and diagnosis was confirmed by biopsy. Juvenile giant fibroadenomas are rare and represent 0.5–2% of all fibroadenomas, their exact etiology is unknown. They affect children and adolescents, with a predominance in African-American females. They may cause breast enlargement and asymmetry. The rapid growth causes anxiety and is the main cause of consultation. These tumors although benign, have to be treated rapidly because they can destruct up to 80% of the surrounding normal breast tissue, and conservatory treatment cannot be done.
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Affiliation(s)
- Lina Belkouchi
- Department of Radiology, Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Siham El Haddad
- Department of Radiology, Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Nidal Mrani Alaoui
- Department of Radiology, Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Nazik Allali
- Department of Radiology, Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Latifa Chat
- Department of Radiology, Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
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13
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Pediatric chest wall masses: spectrum of benign findings on ultrasound. Pediatr Radiol 2022; 52:429-444. [PMID: 34505950 DOI: 10.1007/s00247-021-05196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
A palpable finding along the chest wall is a frequent indication for pediatric US. Accurate identification of benign lesions can reassure families and appropriately triage children who need follow-up, cross-sectional imaging, or biopsy. In this pictorial essay, we review chest wall anatomy, illustrate US techniques and discuss key US imaging features of common benign lesions and normal variants.
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14
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Perez F, Bragg A, Whitman G. Pregnancy Associated Breast Cancer. J Clin Imaging Sci 2022; 11:49. [PMID: 35003831 PMCID: PMC8730537 DOI: 10.25259/jcis_81_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/22/2021] [Indexed: 11/16/2022] Open
Abstract
Pregnancy associated breast cancer (PABC) is a subset of cancer that is too often diagnosed at a more advanced stage due to physiologic changes of the breast and lack of awareness among patients and physicians, resulting in higher mortality rates. While PABC is rare, it is postulated that as women delay childbearing, the rate of PABC may increase. Therefore, it is important to discuss appropriate workup, safety of mammography during pregnancy, and biopsy techniques.
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Affiliation(s)
- Frances Perez
- Department of Breast Imaging, UT Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ashley Bragg
- Department of Breast Imaging, UT Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Gary Whitman
- Department of Breast Imaging, UT Texas MD Anderson Cancer Center, Houston, Texas, United States
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15
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Dubin I, Mortazavi S, Yu T, Riahi IR, Baker JL. Superficial angiomyxoma of the breast in a 16-year-old girl without carney's complex: A case report. Breast J 2021; 27:887-889. [PMID: 34862711 DOI: 10.1111/tbj.14301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022]
Abstract
Superficial angiomyxoma (SA) is a rare benign soft-tissue tumor, arising sporadically or as the earliest manifestation of Carney's complex. When it arises sporadically, the breast is infrequently involved with only few cases reported in the literature. Key imaging findings include T2 signal hyperintensity on MRI and hypervascularity. In this study, we report the clinical, radiological, surgical, and histopathologic findings of a case of sporadic SA of the breast in a 16-year-old girl.
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Affiliation(s)
- Iram Dubin
- Department of Radiological Sciences, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Shabnam Mortazavi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tiffany Yu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Irene R Riahi
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer L Baker
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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16
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Fehr CA, Went P, Maranta M, Cathomas R. A Rare Case of Breast Malignancy in an Adolescent Woman: Lessons Learned from Diagnosis and Management. BREAST CARE (BASEL, SWITZERLAND) 2021; 16:539-543. [PMID: 34720814 DOI: 10.1159/000512975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022]
Abstract
Introduction Primary breast malignancy in adolescent women is very rare and differs in several aspects from findings in adult women. Case Presentation A young woman aged 16 years presented with a locally aggressive breast tumor. The patient received cisplatin-based chemotherapy followed by tumor resection assuming a diagnosis of germ cell tumor. Four months later, she developed locally recurrent disease and underwent a mastectomy. No definite diagnosis was agreed upon despite intensive pathological workup. Subsequent management consisted of follow-up only and the patient remains in complete remission 9 years later. Conclusion This case demonstrates the difficulty of diagnosis and management of rare malignancies in adolescents, and highlights the importance of international and interdisciplinary collaboration in diagnosis and clinical decision-making.
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Affiliation(s)
- Célina Alexandra Fehr
- Department of Internal Medicine, Division of Oncology/Hematology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - Philip Went
- Department of Pathology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - Martina Maranta
- Department of Gynecology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - Richard Cathomas
- Department of Internal Medicine, Division of Oncology/Hematology, Cantonal Hospital of Graubünden, Chur, Switzerland
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17
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Singh S, Gaur K, Puri A. Mammary Fibrocystic Change in a Pre-Pubertal child- A Case Report with a Histopathological Perspective. Fetal Pediatr Pathol 2021; 40:535-539. [PMID: 32075463 DOI: 10.1080/15513815.2020.1721739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Fibrocystic change in the breast is one of the entities under the spectrum of benign breast disease. It occurs primarily in females of the reproductive age group. Though the exact etiology is unknown, estrogen-progesterone imbalance is possibly one of the causative factors. Its occurrence in the pediatric age group is infrequent and is hitherto unreported in the pre-pubertal age group. Case report: We present the case of a 2-year-old female presenting with an ill -defined lump approximately 4 cm in diameter, with an unremarkable hormonal status for the age. Histopathology revealed fibrocystic change in the resected tissue. Conclusion: Fibrocystic breast change in children may represent an exaggeration of the normal developmental involution process.
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Affiliation(s)
- Smita Singh
- Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Kavita Gaur
- Pathology, Lady Hardinge Medical College, New Delhi, India
| | - Archana Puri
- Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India
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18
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Restrepo R, Cervantes LF, Swirsky AM, Diaz A. Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation. Pediatr Radiol 2021; 51:1959-1969. [PMID: 34236480 DOI: 10.1007/s00247-021-05099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/01/2021] [Accepted: 05/02/2021] [Indexed: 10/20/2022]
Abstract
Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA.
| | - Luisa F Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Ave., Miami, FL, 33155, USA
| | | | - Alejandro Diaz
- Division of Pediatric Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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19
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20
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Ait Ichou J, Gauvin S, Faingold R. Ultra-high-frequency ultrasound of superficial and musculoskeletal structures in the pediatric population. Pediatr Radiol 2021; 51:1748-1757. [PMID: 33666733 DOI: 10.1007/s00247-021-04978-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
Because of its relatively low cost, lack of ionizing radiation and great versatility, US is considered the imaging modality of choice to evaluate a large variety of pediatric conditions. Imaging of superficial structures and small anatomical parts can be at times limited with standard US. Recent advances in technology yielded ultra-high-frequency US systems that are capable of scanning with frequencies as high as 70 MHz and resolutions of 30 μm. This technology, approved by the United States Food and Drug Administration, has not been widely used in the clinical setting. It has the potential to become a powerful diagnostic tool in clinical practice, especially in the evaluation of infants, given their inherent body habitus. Our main objective is to discuss the use of ultra-high-frequency US at a tertiary care center. This pictorial essay presents a gamut of pediatric pathologies pertaining to imaging of the soft tissues and the superficial and musculoskeletal structures. Our aim in this pictorial essay is to highlight and illustrate the role of ultra-high-frequency US in improving the depiction of common and less common pathologies. We think it also helps to gain a new understanding of the normal anatomy in the pediatric population and to display specific features not shown by standard US and, in certain cases, ones that lead to a change in diagnosis.
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Affiliation(s)
- Jamal Ait Ichou
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.
| | - Simon Gauvin
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Ricardo Faingold
- Department of Radiology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada.,Department of Diagnostic Radiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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21
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D'Auria D, Ferrara D, Aragione N, De Chiara C, Argenziano G, Noschese I, Noviello D, Esposito F. Role of ultrasound in diagnosis of neonatal breast enlargement: a newborn case report. Radiol Case Rep 2021; 16:2692-2696. [PMID: 34336074 PMCID: PMC8318999 DOI: 10.1016/j.radcr.2021.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022] Open
Abstract
Neonatal breast enlargement is a hormone-related condition, mostly asymptomatic\physiological, with a well-recognizable sonographic appearance but limited data in the literature. It can be uni-or bilateral. Typically described in the first week of life, the transient lesion disappears spontaneously within 6 months. The main differential diagnosis is neonatal mastitis, a breast tissue infection that requires a specific antibiotic therapy. Knowledge of clinical and imaging findings is crucial, and ultrasound represents a reliable tool which allows a quick identification and an excellent examination of neonatal breast abnormalities. We aim to highlight sonographic classic features of benign neonatal breast enlargement showing how ultrasound rules out real breast masses helping to differentiate between it and mastitis when clinical and laboratory data are inconclusive. We describe a 2-day-old male with bilateral breast swelling more pronounced on the right side.
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Affiliation(s)
- Divina D'Auria
- Department of Advanced Biomedical Sciences, Federico II University Unina, Via Sergio Pansini, Naples, Italy
- Corresponding author.
| | - Dolores Ferrara
- U.O. Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Nunzia Aragione
- Department of Neonatal Pathology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Carolina De Chiara
- Department of Neonatal Pathology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Gioconda Argenziano
- U.O. Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Ivan Noschese
- Department of Advanced Biomedical Sciences, Federico II University Unina, Via Sergio Pansini, Naples, Italy
| | - Domenico Noviello
- U.O. Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
| | - Francesco Esposito
- U.O. Emergency Radiology, A.O.R.N. Santobono-Pausilipon Children Hospital, Via Mario Fiore, Naples, Italy
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22
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Davis J, Liang J, Roh A, Kittrell L, Petterson M, Winton L, Connell M, Viscusi R, Komenaka I, Jamshidi R. Use of breast imaging-reporting and data system (BI-RADS) ultrasound classification in pediatric and adolescent patients overestimates likelihood of malignancy. J Pediatr Surg 2021; 56:1000-1003. [PMID: 33494944 DOI: 10.1016/j.jpedsurg.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE Breast masses in the pediatric population cause patient and family concern, partially driven by public awareness of adult breast cancer. However, the spectrum of breast masses in children differs greatly from that in adults, and malignancy is exceedingly rare. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasound-based classification system is the diagnostic standard, yet no study has validated BI-RADS in pediatric patients. This study compares BI-RADS classification with histologic diagnoses to evaluate BI-RADS validity in pediatric patients. METHODS Multicenter retrospective evaluation of breast masses in patients under 21 years. Ultrasound reports were compared with histologic diagnoses. RESULTS There were 283 patients with breast pathology results after excluding clinical diagnoses of gynecomastia. Mean age was 16.9 (SD 2.3), ranging 10-20 years. 227 had pre-operative ultrasounds, and 84% (191/227) were assigned a BI-RADS category. BI-RADS 4 was the most frequent category (55%, n = 124), by definition predicting 2 - 95% likelihood of malignancy. However, pathology was benign in all patients. CONCLUSIONS The current BI-RADS categorization system overestimates cancer risk when applied to pediatric patients. BI-RADS scores should not be assigned to pediatric patients, and BIRADS-defined recommendations for biopsy should be disregarded. A pediatric-specific classification system could be useful.
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Affiliation(s)
- John Davis
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Juliana Liang
- The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Albert Roh
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Laurel Kittrell
- The University of Arizona College of Medicine, Tucson, Tucson, AZ, United States
| | - Matthew Petterson
- The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Lisa Winton
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Mary Connell
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Rebecca Viscusi
- The University of Arizona College of Medicine, Tucson, Tucson, AZ, United States
| | - Ian Komenaka
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Ramin Jamshidi
- Valleywise Health Medical Center, Phoenix, AZ, United States; The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States; Phoenix Children's Hospital, Phoenix, AZ, United States.
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23
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Avola E, Giannetta V, Depretto C, Scaperrotta GP. Uncommon site of metastatic neuroblastoma in a 15-year-old girl: case report and description of sonographic and radiographic features. TUMORI JOURNAL 2021; 107:NP59-NP62. [PMID: 33759659 DOI: 10.1177/03008916211002260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most breast masses in children are benign, breast cancer must be considered in the differential diagnosis. The majority are represented by sarcomas and secondary lesions. Literature reports only four cases of neuroblastoma breast metastasis, with no emphasis on radiologic features. Our work aims to furnish a description of radiologic and sonographic features of neuroblastoma metastasis in the breast. CASE DESCRIPTION A 15-year-old girl had a round nodular mass in the outer upper quadrant of the left breast that had rapidly enlarged over the last month. An ultrasound showed two subcutaneous nodules (3.8 cm and 1.3 cm in maximum diameter), with an irregular shape, heterogeneous echogenicity (isohypoechoic), and hyperechoic foci with a posterior acoustic shadow inside. Overall, the features were highly suspicious of secondary malignant lesions. Computed tomographic scan was performed and found a large retroperitoneal mass and multiple mixed secondary lesions to the spine and hip. A 14G core needle biopsy of breast masses was performed and showed a secondary localization of neuroblastoma. CONCLUSIONS In adolescents, metastases are the most frequent cause of malignant breast masses. Ultrasound examination should be preferred as the first imaging tool. For the differential diagnosis of breast metastasis with benign masses, a rapid enlargement, a heterogeneous echogenicity, and intralesional hyperechogenic foci could be considered features of malignancy.
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Affiliation(s)
- Emanuele Avola
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Giannetta
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
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24
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Koksal H, Ates D, Kara B. Breast complaints in children and the effect of family history. Pediatr Int 2021; 63:279-283. [PMID: 32745292 DOI: 10.1111/ped.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the correlation of physical examination, and radiological and pathological findings of children and adolescents with breast-related complaints. METHODS Children and adolescents with breast complaints between January 2016 and December 2019 were analyzed retrospectively. RESULTS A total of 118 children and adolescent patients were included. Their ages ranged from 12 to 18 years (median, 16 years). Twenty-one patients had a family history of breast cancer (17.8%). The most common complaints were pain, mass, and nipple discharge. Physical examination revealed mass (41.5%), tenderness (11%), and fullness (8.5%). Thirty-nine patients were classified ultrasonographically with Breast Imaging Reporting and Data System (BIRADS) 3 (39.4%) and four patients were BIRADS 4 (4%). Excision was applied to all patients with BIRADS 4, and 13 of 39 patients with BIRADS 3. Pathological diagnoses of the patients with BIRADS 3 were fibroadenoma (n: 12, 92.3%) and benign phyllodes tumor (n: 1, 7.7%). In patients with BIRADS 4, three patients had fiboradenomas and one patient had a benign phyllodes tumor. No recurrence was observed in any patients who had an excision. Only six of the patients with positive family history had BIRADS 3 lesions, and the others were BIRADS 1. Excision was recommended in two patients and the pathological diagnoses were fibroadenoma. CONCLUSION In this age group, the most common complaints were pain and mass, while physical examination was normal in nearly half of the patients. All of the pathological diagnoses were benign. While evaluating the patients in this age range, the experience of the clinician and radiologist is important and we think that it is necessary to increase the awareness of the patient and family about physiological breast development and self-breast examination.
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Affiliation(s)
- Hande Koksal
- Department of General Surgery, Hamidiye Faculty of Medicine, Konya Education and Research Hospital, Saglik Bilimleri University, Konya, Turkey
| | - Dervis Ates
- Department of General Surgery, Hamidiye Faculty of Medicine, Konya Education and Research Hospital, Saglik Bilimleri University, Konya, Turkey
| | - Buket Kara
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
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25
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Abstract
<br><b>Introduction:</b> Fibroadenomas are one of the most common benign tumors of the breast in the adolescent females accounting for about 2/3<sup>rd</sup> of all the breast lumps and more than half of all the biopsied breast lesions. They come into being due to overgrowth of glandular tissue under the influence of hormonal changes that the girls undergo at the time of puberty. Due to the wide prevalence of fibroadenomas and the psychosocial morbidity associated with the finding of a breast mass, it is imperative for physicians treating adolescent patients to be thoroughly familiar and updated with this disease. <br><b>Aim:</b> The article aims at providing a brief review of the classification, presentation, diagnosis, and update on the management of breast fibroadenomas on the basis of recent literature.
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26
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Alawi A, Hasan M, Harraz MM, Kamr WH, Alsolami S, Mowalwei H, Salem A, Qronfla H. Breast lesions in women under 25 years: radiologic-pathologic correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00209-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The majority of breast lesions in women under 25 years are being benign. Imaging is important for diagnosis and selecting patients for further procedures. Although malignancy is rare in this group of patients, suspected lesions must be biopsied. Imaging is very important in the selection of patients for radiological intervention. Understanding of the clinical, pathologic, and imaging features allows the radiologist to guide proper management of these patients. The aim of this study was to determine the frequency of different breast lesions in symptomatic women under 25 years and the value of radiological imaging in the diagnosis.
Results
This was a retrospective study; a total number of 250 cases with breast lumps under 25 years of age were registered in the PACKS of our institution in the period from January 01, 2017 to December 31, 2018. Two hundred three cases coped with our inclusion criteria that include available histopathological results either by biopsy or after surgery based on their referring physicians decision. Our exclusion criteria were those cases (47) with definite BIRADS 2 lesions with no available pathology reports. Ultrasonography was done to all patients (203 cases) and MRI was performed to 26 cases. All cases were histologically verified; their findings were reviewed and compared to radiological findings.
A total of 203 symptomatic breast lesions were received at the radiological department in women under 25 years; there were 115 (56.7%) benign, 85 (41.9%) cystic, and 3 (1.5%) malignant lumps. The commonest benign lesion was fibroadenoma (104 cases, 51.2%) and all the malignant lesions were invasive ductal carcinoma (IDC) (3 cases, 1.47%). The p value is > 0.05, so there were no differences between examination using the ultrasonography and the MRI imaging compared to histopathological results.
Conclusions
Most breast lesions in young women are benign. Ultrasonography is an essential first imaging modality in the diagnosis of women under 25 years with breast lesions.
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27
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Fibroadenomas: a multidisciplinary review of the variants. Clin Imaging 2020; 71:83-100. [PMID: 33186871 DOI: 10.1016/j.clinimag.2020.10.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/02/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022]
Abstract
Fibroadenomas are the most common benign breast lesions in women. Hormonal activities, particularly an increase in oestrogenic activity, have an important role in the aetiology of fibroadenomas. They are commonly detected incidentally. Most fibroadenomas have similar imaging findings and these lesions can be defined as simple fibroadenomas (SFAs). However, due to different histopathologic characteristics and components, variants of fibroadenomas have been described. These variants include; juvenile, giant, complex, myxoid, cellular, and hyalinised fibroadenomas. The diagnoses of these variants are important. They have different clinical behaviours, potential for malignant transformation, and treatment strategies. We present imaging findings of SFAs and other variants of fibroadenomas. To our knowledge, there is no review in which imaging findings of all fibroadenoma variants are presented together.
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28
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Zmora O, Klin B, Iacob C, Meital A, Mendlovic S, Karni T. Characterizing excised breast masses in children and adolescents-Can a more aggressive pathology be predicted? J Pediatr Surg 2020; 55:2197-2200. [PMID: 32061367 DOI: 10.1016/j.jpedsurg.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/22/2019] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Our aim was to characterize excised breast masses in children and adolescent and to identify factors associated with a more aggressive pathology. METHODS Retrospective review of all female patients <19 who underwent excision of breast masses at our institution between 1999 and 2018. Demographic, clinical, imaging, pathological and management data were collected. We assessed possible association of any of the variables with a more aggressive pathology (phyllodes tumor and malignancy). Correlation between core needle biopsy results and final pathology results was also calculated. RESULTS 70 patients were included. Median age was 17 years (range: 11-19). Resected mass size was 4 cm (range: 2-16). Final pathology results were: fibroadenoma (49), juvenile fibroadenoma (7), hamartoma (5), benign phyllodes (7), malignant phyllodes (1) and sarcoma (1). Pathology was benign in 61 (87%) patients and more aggressive (phyllodes and sarcoma) in 9 (13%). None of the tested variables was associated with a more aggressive pathology. Presurgical core biopsy results matched final pathology in only 63.6%. CONCLUSIONS Excised breast masses in children and adolescents are sometimes of a more aggressive pathology, which cannot be predicted by presurgical factors, including a core needle biopsy. Prognosis study LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Baruch Klin
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catalin Iacob
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aaron Meital
- Department of Pediatric Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sonia Mendlovic
- Department of Pathology, Shamir (Assafh Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Karni
- Department of General Surgery, Shamir (Assaf Harofeh) Medical Center, Zerifin, Be'er Ya'akov, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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29
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Olarinoye-Akorede SA, Ibinaiye PO, Suleiman LB. Ultrasonographic review of pediatric breast masses among Nigerian children in a tertiary hospital. Afr J Paediatr Surg 2020; 17:54-58. [PMID: 33342834 PMCID: PMC8051630 DOI: 10.4103/ajps.ajps_57_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Breast masses occur infrequently in children and adolescents. Most of these masses have proved that benign and conservative approach is the management of choice. Consequently, imaging has become crucial. The knowledge of the ultrasonographic features of childhood and adolescent breast masses is needed for age appropriate medical care. AIM The aim of this study was to describe and document the ultrasonographic spectrum of breast masses in children and adolescents (0-19) years seen in the Ahmadu Bello University teaching hospital, Zaria. MATERIALS AND METHODS A 2-year retrospective review of breast sonograms of 25 consecutively presenting children and adolescents (3 males and 22 females) who had palpable breast masses. Ultrasound scans were performed with a Mindray Machine DC-8 using the linear transducer at 7.5-12 MHz transducer frequency. Histopathological confirmation of the solid masses was also obtained. The statistical analysis of the data collected was done using the SPSS software version 20 (SPSS Inc., Chicago, IL, USA). RESULTS The patients were between 40 days and 19 years old (mean 14.8 years and standard deviation 4.1). The ultrasonographic findings were those of infections, benign tumoral lesions and pubertal endocrine changes. Overall, fibroadenoma was the most common mass, seen in 14 (56%) of the patients. Other findings were simple cysts, non-puerperal and puerperal mastitis, juvenile papillomatosis and normal glandular pubertal breast tissue. The three male patients had gynaecomstia, pseudogynaecomastia and cystic lymphangioma of the chest wall presenting as unilateral breast masses, respectively. There was no malignancy recorded in any of the patients. CONCLUSION Ultrasonographically, benign masses predominate which is concordant with surgical findings. Familiarity with these features would obviate the need for unnecessary invasive procedures which should be reserved for only deserving cases.
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Affiliation(s)
| | | | - Lawal B Suleiman
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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30
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Wright AG, Hayward JH, Price ER, Ray KM, Joe BN, Lee AY. Primum non nocere: Utility and outcomes of pediatric breast ultrasound. Clin Imaging 2020; 68:131-135. [PMID: 32599442 DOI: 10.1016/j.clinimag.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the use and outcomes of ultrasound for the evaluation of breast signs and symptoms in pediatric females. METHODS A retrospective database review identified all patients ≤18-years-old who underwent breast ultrasound at an academic institution over a 20-year period. Each symptomatic site was designated a case and analyses were performed on each case. Imaging findings were obtained from the radiology reports. Clinical and pathology data were obtained from the medical records. Descriptive statistics were performed. RESULTS The final cohort comprised 124 cases in 101 patients. Mean age was 15 years (range 1-18). The most common indication for ultrasound was a palpable lump (71%). Thirty-seven cases (30%) demonstrated no sonographic correlate to the symptom; 36 (29%) had a benign correlate. The most common benign correlates were abscess/phlegmon and cyst. All cases of abscess/phlegmon had infectious symptoms. Fifty-one cases (41%) demonstrated a sonographic mass that was not characteristically benign. Of these indeterminate masses, 27 were recommended for biopsy, 13 for short-interval follow-up, and 6 had no recommendation. Of 27 biopsied masses, 63% were fibroadenomas. No symptoms were due to malignancy. Therefore, the NPV of ultrasound was 100% and the PPV 0%. CONCLUSION In this cohort of pediatric and adolescent patients, malignancy was never the cause of breast symptoms. Imaging yielded false positives with a biopsy recommendation in 22% of cases. Ultrasound provided value in evaluating infectious symptoms. Given the extreme rarity of breast cancer in this population, surveillance may be a safe alternative for most indeterminate lesions.
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Affiliation(s)
- Alexandra G Wright
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jessica H Hayward
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Elissa R Price
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Kimberly M Ray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
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31
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Wu IK, Lai YC, Chiou HJ, Hsu CY. Secretory Carcinoma of the Breast: A Case Report and Literature Review. J Med Ultrasound 2020; 29:57-59. [PMID: 34084719 PMCID: PMC8081107 DOI: 10.4103/jmu.jmu_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Secretory carcinoma of the breast is a rare subtype of breast cancer. It can occur at any age but is usually diagnosed in patients under 30 years. It is the most common subtype of breast malignancy in the pediatric population and has a favorable outcome. Surgical excision is the best treatment and adjuvant therapies are still under debate. We present the case report of a 26-year-old patient with secretory carcinoma of the breast, including imaging, histologic findings, and clinical outcome.
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Affiliation(s)
- I-Kai Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Yi Hsu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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32
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Durakbaşa ÇU, Erkoç G, Çağlar Oskaylı M, Şeneldir H, Mutuş M, Aksu B, Pirim A. A retrospective evaluation of pediatric breast fibroadenomas with mid-term follow-up results. Breast J 2020; 26:1898-1899. [PMID: 32281202 DOI: 10.1111/tbj.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/15/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Çiğdem Ulukaya Durakbaşa
- Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gürkan Erkoç
- Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Meltem Çağlar Oskaylı
- Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Hatice Şeneldir
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Murat Mutuş
- Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Burhan Aksu
- Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Pirim
- Department of Pediatric Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
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33
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Sun C, Zhang W, Ma H, Han N, Qi M, Li D, Wang X, Wang X, Yang J. Main Traits of Breast Fibroadenoma Among Adolescent Girls. Cancer Biother Radiopharm 2020; 35:271-276. [PMID: 32267738 DOI: 10.1089/cbr.2019.3209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: To investigate the clinicopathological features of breast fibroadenoma among female teenagers and provide some bases for its diagnosis and treatment, the authors conducted this study. Methods: Retrospective analysis on 80 female teenagers with fibroadenoma was carried out. The histological sections of H&E were reviewed, and immunohistochemical staining with ki67, CD34, and SMA were performed. The patients were followed up. Results: The age of included patients ranged from 12 to 18 years old, with a mean age of 17. Bilateral lesions occurred in 10% of the patients, and mean tumor diameter was 2.8 cm. Histologically, tumors in most cases showed clear boundary with no capsule. Also, 90% of the cases were confirmed to be pericanalicular mixed types, while about 20% had atypical foliation structure. The mean density of mesenchymal cells was 30%. The upper limit of mitotic figure was 2/10HPF in 80% of the cases, and the positive index of ki-67 was no more than 5% in 80% of cases. Sixteen percent of the cases also simultaneously suffered epithelial micropapillary hyperplasia. Six cases (6/39, 15%) faced relapse after tumor resection, with an average recurrence interval of 4.9 years after surgery. Tumor size, mitotic activity, ki67 positive index, and the density of mesenchymal cells were not associated with relapse. Conclusions: Adolescent fibroadenoma is a group of biphasic breast tumors with unique clinical and pathological features. Although fibroadenoma shows a local recurrence rate to a certain degree, its recurrent lesions grow slowly.
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Affiliation(s)
- Chunjie Sun
- Department of Pathology and Tongzhou Maternal and Child Health Hospital of Beijing, Beijing , China
| | - Wanlong Zhang
- Department of Pathology and Tongzhou Maternal and Child Health Hospital of Beijing, Beijing , China.,Department of Traditional Chinese Medicine, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing , China
| | - Haihui Ma
- Department of Obstetrics, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Na Han
- Department of Obstetrics, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Menghu Qi
- Department of Pediatrics, and Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Donglian Li
- Department of Pathology and Tongzhou Maternal and Child Health Hospital of Beijing, Beijing , China
| | - Xiaojing Wang
- Department of Pathology and Tongzhou Maternal and Child Health Hospital of Beijing, Beijing , China
| | - Xuehui Wang
- Department of Pathology and Tongzhou Maternal and Child Health Hospital of Beijing, Beijing , China
| | - Jie Yang
- Department of Information, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
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34
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Du F, Dong R, Zeng A, Liu Z, Yu N, Wang X, Zhu L. Surgical management of giant juvenile fibroadenoma with skin reducing tumor resection and immediate breast reconstruction: A single-center experience. J Surg Oncol 2020; 121:441-446. [PMID: 31907948 DOI: 10.1002/jso.25828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Giant juvenile fibroadenoma (GJF) is a rare benign tumor that disfiguring affects the breast shape and quality of life of patients. This study aimed to report the experience of GJF management. METHODS A Wise-pattern skin reducing tumor resection followed by immediate breast reconstruction with a dermal flap pocket was used. The long-term outcomes were assessed retrospectively by BREAST-Q questionnaire from 2008 to 2018. RESULTS The study included eight patients with GJF. All patients achieved satisfactory results without severe complications. The BREAST-Q revealed that postoperative scores for satisfaction with breasts (69.3 ± 17.6) and sexual wellbeing (62.3 ± 27.6) were higher than the normative scores. The psychosocial wellbeing (69.7 ± 14.6) and physical wellbeing-chest (86.8 ± 13.0) scores were slightly lower than the normative scores. CONCLUSION Although GJF is a benign tumor, it should be surgically removed. And the Wise-pattern skin reducing tumor resection with immediate breast reconstruction is a proper way to improve patients' satisfaction with breast size and shape and quality of life.
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Affiliation(s)
- Fengzhou Du
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruijia Dong
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ang Zeng
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhifei Liu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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35
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Moon S, Lim HS, Ki SY. Ultrasound Findings of Mammary Duct Ectasia Causing Bloody Nipple Discharge in Infancy and Childhood. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2793-2798. [PMID: 30768798 DOI: 10.1002/jum.14970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 06/09/2023]
Abstract
Bloody nipple discharge in infancy and childhood is extremely rare, and mammary duct ectasia is the most common etiology. Ultrasound (US) findings of mammary duct ectasia include dilated ducts and tubular anechoic lesions that may contain echogenic debris in the subareolar region. However, mammary duct ectasia may show variable US findings, which are not well described in the literature. We report 3 cases of mammary duct ectasia in infancy and childhood with variable imaging findings, including complex cystic and solid lesions. Detailed initial clinical and US findings and serial follow-up US images are described.
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Affiliation(s)
- Sungmin Moon
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-eup, Korea
| | - So Yeon Ki
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
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36
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Anomalie mammaire clinique chez l’enfant et l’adolescent : physiologique ou pathologique ? IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Popli V, Popli MB. Juvenile Fibroadenoma at Menarche: A Case Series. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318824301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Juvenile fibroadenomas of the breast are benign neoplasms. They present during the development phase of the breast. They are poorly understood because of their rarity and unpredictable behavior. In this article, a series of three different sonographic breast cases are provided of adolescent girls, who were brought for medical evaluation of a large breast lump, which had presented just after menarche. The results of evaluating these cases revealed that sonography of the breast was helpful in characterizing and delineating the extent of the lump. In conclusion, giant fibroadenomas of the breast, at menarche, are also known as juvenile fibroadenomas. They are a dilemma for the clinician, radiologist, and pathologist alike. The use of ultrasound can assist with characterizing these lesions, as an incorrect diagnosis could lead to a disfiguring surgery, for a young girl.
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Affiliation(s)
- Vineet Popli
- Dr Baba Saheb Ambedkar Hospital, Pediatrics, Delhi, India
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38
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Pathologic discordance to clinical management decisions suggests overtreatment in pediatric benign breast disease. Breast Cancer Res Treat 2019; 176:101-108. [PMID: 30982196 DOI: 10.1007/s10549-019-05224-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Breast masses in pediatric patients are often managed similarly to adult breast masses despite significant differences in pathology and natural history. Emerging evidence suggests that clinical observation is safe. The purpose of this study was to quantify the clinical appropriateness of the management of benign breast disease in pediatric patients. METHODS A multi-institutional retrospective cohort study was completed between 1995 and 2017. Patients were included if they had benign breast disease and were 19 years old or younger. A timeline of all interventions (ultrasound, biopsy, or excision) was generated to quantify the number of patients who were observed for at least 90 days, deemed appropriate care. To quantify inappropriate care, the number of interventions performed within 90 days, and the pathologic concordance to clinical decisions was determined by reviewing the radiology reports of all ultrasounds and pathology reports of all biopsies and excisions. RESULTS A total of 1,909 patients were analyzed. Mean age was 16.4 years old (± 2.1). The majority of masses were fibroadenomas (60.4%). Only half of patients (54.3%) were observed for 90 or more days. 81.1% of interventions were unnecessary, with pathology revealing masses that would be safe to observe. The positive predictive value (PPV) of clinical decisions made based on suspicious ultrasound findings was 16.2%, not different than a PPV of 21.9% (p < 0.25) for decisions made on clinical suspicion alone. CONCLUSION Despite literature supporting an observation period for pediatric breast masses, half of patients had an intervention within three months with one out of ten patients undergoing an invasive procedure within this time frame. Furthermore, 81.1% of invasive interventions were unnecessary based on final pathologic findings. A formal consensus clinical guideline for the management of pediatric benign breast disease including a standardized clinical observation period is needed to decrease unnecessary procedures in pediatric patients with breast masses.
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39
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Management of Palpable Pediatric Breast Masses With Ultrasound Characteristics of Fibroadenoma: A More Conservative Approach. AJR Am J Roentgenol 2019; 212:450-455. [DOI: 10.2214/ajr.17.19482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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40
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Bhayana A, Misra RN, Bajaj SK, Bankhar H. Clinicoradiologicial aspects of secretory carcinoma breast: A rare pediatric breast malignancy. Indian J Radiol Imaging 2019; 28:448-451. [PMID: 30662208 PMCID: PMC6319105 DOI: 10.4103/ijri.ijri_46_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group. We report imaging and clinicopathological features of secretory carcinoma breast with distant and axillary metastasis, in an 11-year-old girl, who presented with a painful lump in right breast. Ultrasound revealed a well-defined, partially microlobulated hypoechoic mass with skin and pectoralis muscle involvement and a suspicious morphology right axillary lymph node. Color Doppler revealed increased vascularity in both the breast mass and suspicious axillary node. Magnetic resonance imaging helped in better evaluation of pectoralis muscle involvement. Computed tomography (CT) neck, chest, and abdomen revealed multiple fibronodular opacities in bilateral lung fields. 18 Flouro-Deoxy-Glucose Positron Emission Tomography (FDG PET-CT) showed a hypermetabolic retroareolar breast mass with multiple hypermetabolic bilateral lung nodules suggesting lung metastasis. The histopathology confirmed the diagnosis of secretory carcinoma. The patient was offered chemotherapy for 2 years and put on follow-up since then.
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Affiliation(s)
- Aanchal Bhayana
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ritu N Misra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil K Bajaj
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Himani Bankhar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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41
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Westfal ML, Chang DC, Kelleher CM. A population-based analysis of pediatric breast cancer. J Pediatr Surg 2019; 54:140-144. [PMID: 30352693 DOI: 10.1016/j.jpedsurg.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to evaluate trends in demographics and outcomes of pediatric breast cancer in a United States population-based cohort. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant breast tumors between 1973 and 2014. Analysis was performed using Stata Statistical Software version 13.1. Associations between categorical variables were made using X2 test. Log-rank test was used for univariate survival analysis. Kaplan-Meier analysis investigated five-year survival rates across several variables. Adjusted analysis was performed using a Cox Proportional-Hazards regression. RESULTS 134 patients with breast malignancies were identified. Carcinoma was the most prevalent histology (48.5%), followed by fibroepithelial tumors (FETs) (35.1%), and sarcoma (14.2%). FETs were twice as common in black compared to nonblack patients (56.3% vs. 29.0%, p < 0.01). Analyzing histology by stage revealed that 100% of FETs were early stage disease (p < 0.0001). 46.7% of the tumors tested were ER/PR negative, more than twice as many compared to the published adult estimate of 20.0%. Unadjusted survival analysis revealed worse survival for patients with adenocarcinoma/sarcomas, advanced stage, and high grade disease, without a survival difference between races. CONCLUSION Breast cancer remains a rare malignancy among pediatric patients. Although black patients were found to have more noncarcinomatous tumors with less advanced disease, this did not confer a survival advantage. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Maggie L Westfal
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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42
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Abstract
Neonatal breast enlargements have varying number of presentations on imaging and these have been underreported in the literature. Our case report profiles a 2-week-old female who presented with a history of bilateral breast enlargement with redness and clear, non-bloody, milk-like discharge, who was clinically diagnosed and managed for neonatal mastitis, which was actually a neonatal breast enlargement only. Awareness on neonatal breast enlargement that can be just physiological without any associated mastitis or inflammatory/infective changes can prevent unnecessary hospitalization and treatment with parenteral antibiotics.
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Affiliation(s)
- Bhumika Suthar
- Department of Radiodiagnosis, Baroda Medical College, Maharaja Sayajirao University, Vadodara, India
| | - Kanishka Aggarwal
- Department of Radiodiagnosis, Baroda Medical College, Maharaja Sayajirao University, Vadodara, India
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43
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Javed A, Jenkins SM, Labow B, Boughey JC, Lemaine V, Neal L, Shah SS, Pruthi S. Intermediate and long‐term outcomes of fibroadenoma excision in adolescent and young adult patients. Breast J 2019; 25:91-95. [DOI: 10.1111/tbj.13159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Asma Javed
- Division of Pediatric and Adolescent Gynecology Mayo Clinic Rochester Minnesota
| | - Sarah M. Jenkins
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | - Brian Labow
- Department of Plastic and Oral Surgery Boston Children’s Hospital Boston Massachusetts
| | | | | | - Lonzetta Neal
- Division of General Internal Medicine Mayo Clinic Rochester Minnesota
| | - Sejal S. Shah
- Division of Anatomic Pathology Mayo Clinic Rochester Minnesota
| | - Sandhya Pruthi
- Division of General Internal Medicine Mayo Clinic Rochester Minnesota
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44
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Omar L, Pfeifer CM, Kulkarni S, Sharma P, Sengupta A, Kwon JK. Granular cell tumor in a premenstrual female breast. Clin Imaging 2018; 52:334-336. [DOI: 10.1016/j.clinimag.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/15/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
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45
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Bruserud IS, Roelants M, Oehme NHB, Eide GE, Bjerknes R, Rosendahl K, Júlíusson PB. Ultrasound assessment of pubertal breast development in girls: intra- and interobserver agreement. Pediatr Radiol 2018; 48:1576-1583. [PMID: 29982956 DOI: 10.1007/s00247-018-4188-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound (US), aiming for a more objective analysis. However, information regarding its reliability is lacking. OBJECTIVE To examine intra- and interobserver agreement of breast maturity staging using US and to examine the precision of direct measurements of the gland. MATERIALS AND METHODS Fifty-seven healthy girls (mean age: 10.9 years, range: 6.1 to 15.9 years) were examined independently by two observers using US of the left breast to score the glandular maturity stage on a 0-5 scale, and to measure the depth and diameter. One observer repeated the examination after 20 to 35 min to assess intra-observer agreement. Cohen's kappa with linear weights was used to examine intra- and interobserver agreement of the US staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement. RESULTS The agreement of US staging on a 0-5 scale was very good (kappa 0.84; 95% confidence interval [CI] 0.78-0.91) for intra-observer observation and good (kappa 0.71; 95% CI 0.62-0.80) for interobserver observation. Measurements of glandular depth and diameter were unbiased for a single observer, but the variances were large both within and between observers. CONCLUSION US using a scale from 0 to 5 is a reliable method to stage the development of glandular breast tissue during puberty in healthy girls. Measurements of glandular depth and diameter were found to be imprecise.
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Affiliation(s)
- Ingvild Særvold Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ninnie Helén Bakken Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
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46
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An unusual cause of a breast mass in a 13-year-old girl: a case report. J Med Case Rep 2018; 12:236. [PMID: 30157954 PMCID: PMC6116378 DOI: 10.1186/s13256-018-1761-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents rarely present with breast lumps, and such lumps are usually due to benign causes. Foreign bodies in the breast are an uncommon finding and could be detected incidentally during imaging or be symptomatic and present as a painful mass. Sometimes they cause diagnostic dilemmas as they mimic malignancies. To the best of our knowledge, this is the second case reported in the literature about an abscess caused by a migrating retained temporary epicardial pacing wire. CASE PRESENTATION A 13-year-old girl of African ancestry was referred to our clinic with a left breast mass that had been gradually increasing in size for 2 years. The mass was tender but was not associated with skin changes, nipple discharge, or fever. She had a history of rheumatic heart disease and had undergone mitral and tricuspid valve repair more than 2 years ago. Blood work and biochemistry were within normal ranges. An ultrasound of her left breast showed a large, irregular, complex, heterogeneous mass measuring 4.3 × 2.7 × 3.5 cm at 6 o'clock position with central cystic changes but no significant intrinsic vascular flow. There was significant associated skin and subcutaneous edema. Given the echogenicity of the mass, an infectious cause was considered likely, and malignancy was less likely but could not be excluded. An ultrasound-guided biopsy was performed and revealed cores of breast tissue heavily infiltrated with mixed acute and chronic inflammatory cells, consistent with a chronic abscess. She received a 10-day course of antibiotics. However, she remained symptomatic, and the mass did not decrease in size. Therefore, we proceeded to surgical excision. The breast mass was excised. It was fixed to the underlying rib, and a thin, long, metallic wire that moved with her heartbeat was observed protruding from a small opening above the rib. This was a migrated retained epicardial pacing wire from the previous valve repair surgery. The histopathology of the mass revealed mammary tissue with acute and chronic inflammatory cells. CONCLUSION Temporary epicardial pacing wires should be removed completely by cardiothoracic surgeons after surgery to avoid migration that might lead to unexpected complications.
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Tay TKY, Guan P, Loke BN, Nasir NDM, Rajasegaran V, Thike AA, Lian D, Chang KTE, Teh BT, Ng CCY, Tan PH. Molecular insights into paediatric breast fibroepithelial tumours. Histopathology 2018; 73:809-818. [PMID: 29969836 DOI: 10.1111/his.13701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 07/01/2018] [Indexed: 12/13/2022]
Abstract
AIMS This study aims to examine the molecular genetics of paediatric breast fibroepithelial tumours through the targeted sequencing of 50 genes. METHODS AND RESULTS Formalin-fixed paraffin-embedded tissues of fibroepithelial tumours diagnosed in a cohort of patients aged 18 years and below were subjected to next generation sequencing using the Haloplex Target Enrichment System. Twenty-five conventional and 17 juvenile fibroadenomas were studied, with MED12 mutations found in 53.8 and 35% of the tumours, respectively. There was also one benign fibroepithelial neoplasm with hybrid features of juvenile papillomatosis and infarcted benign phyllodes tumour-like areas. Most tumours did not have mutations in well-known cancer driver genes, none harboured TERT promoter mutations, while 25.6% (11 of 43) showed no mutations. Metachronous and synchronous tumours were found to have mutational heterogeneity with some containing mutations in MED12; other genes or no mutations were detected at all. Four of eight giant fibroadenomas (size 5 cm or larger) had no mutations detected, suggesting that there are other molecular mechanisms driving their growth. Tumours with MED12 mutations incidentally had a significantly higher stromal mitotic count compared with those without. CONCLUSION While paediatric fibroepithelial lesions can have cellular stroma potentially raising concern for phyllodes tumour, their lack of TERT promoter and cancer driver mutations is reassuring. The absence of mutations in a significant proportion of tumours, especially the giant fibroadenomas, warrants investigation of pathogenetic mechanisms beyond those involving the 50 genes.
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Affiliation(s)
- Timothy K Y Tay
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Peiyong Guan
- Laboratory of Cancer Epigenome, National Cancer Centre, Singapore
| | - Benjamin N Loke
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Nur Diana M Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | | | - Aye Aye Thike
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Derrick Lian
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre, Singapore
| | - Cedric C Y Ng
- Laboratory of Cancer Epigenome, National Cancer Centre, Singapore
| | - Puay-Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
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Lee EJ, Chang YW, Oh JH, Hwang J, Hong SS, Kim HJ. Breast Lesions in Children and Adolescents: Diagnosis and Management. Korean J Radiol 2018; 19:978-991. [PMID: 30174488 PMCID: PMC6082765 DOI: 10.3348/kjr.2018.19.5.978] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 11/15/2022] Open
Abstract
Pediatric breast disease is uncommon, and primary breast carcinoma in children is extremely rare. Therefore, the approach used to address breast lesions in pediatric patients differs from that in adults in many ways. Knowledge of the normal imaging features at various stages of development and the characteristics of breast disease in the pediatric population can help the radiologist to make confident diagnoses and manage patients appropriately. Most breast diseases in children are benign or associated with breast development, suggesting a need for conservative treatment. Interventional procedures might affect the developing breast and are only indicated in a limited number of cases. Histologic examination should be performed in pediatric patients, taking into account the size of the lesion and clinical history together with the imaging findings. A core needle biopsy is useful for accurate diagnosis and avoidance of irreparable damage in pediatric patients. Biopsy should be considered in the event of abnormal imaging findings, such as non-circumscribed margins, complex solid and cystic components, posterior acoustic shadowing, size above 3 cm, or an increase in mass size. A clinical history that includes a risk factor for malignancy, such as prior chest irradiation, known concurrent cancer not involving the breast, or family history of breast cancer, should prompt consideration of biopsy even if the lesion has a probably benign appearance on ultrasonography.
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Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jung Hee Oh
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea
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Durmaz E, Öztek MA, Arıöz Habibi H, Kesimal U, Sindel HT. Breast diseases in children: the spectrum of radiologic findings in a cohort study. Diagn Interv Radiol 2018; 23:407-413. [PMID: 29033391 DOI: 10.5152/dir.2017.17033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to investigate the spectrum of radiologic findings and referral reasons for breast diseases in children considering age-appropriate presentation. METHODS Our retrospective cohort study included 348 consecutive pediatric patients aged <19 years (median, 13 years) referred to radiology with a clinical presentation between 2005 and 2016. Radiologic findings were reviewed in four age ranges (0-2 years, 2-8 years, 8-15 years, >15 years). RESULTS Of 348 patients, 257 had a referral reason. The most frequent referral reason was a palpable mass (35%). Developmental abnormalities accounted for 48% of all radiologic findings in 348 patients. We did not detect any breast malignancy. According to age groups, the most common radiologic findings were neonatal hypertrophy (0-2 years), early breast development (2-8 years), developmental abnormalities by a majority of gynecomastia (8-15 years), and normal findings or developmental abnormalities (>15 years). Interestingly, the frequency of gynecomastia was only 4% in neonatal period or early childhood. Fibroadenomas and fibroadenoma-like solid masses were seen after 8 years and constituted the majority of solid masses (65%). Cysts were seen at a rate of 7% and majority of them were of simple type, which tends to resolve in time. CONCLUSION In our study, the most common referral reason to radiology was a palpable breast mass. Neonatal hypertrophy and early breast development in younger children, and developmental abnormalities in older children may be kept in mind as the most common radiologic findings. Our study confirms the substantial absence of malignancies in children as well as a widely different disease spectrum in comparison with the adult population.
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Affiliation(s)
- Emel Durmaz
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey.
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50
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Bayramoglu Z, Kebudi R, Yilmaz R, Buyukkapu Bay S, Kebudi A, Karanlik H, Iribas A, Darendeliler E, Onder S, Bilgic B, Adaletli I. Primary Rhabdomyosarcoma of the Breast: Imaging Findings and Literature Review. Breast Care (Basel) 2018; 13:293-297. [PMID: 30319332 DOI: 10.1159/000487750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Primary breast rhabdomyosarcoma (RMS) can occur in children. There is a lack of knowledge regarding radiologic findings and added diffusion-weighted magnetic resonance imaging (MRI) features of RMS in the literature. Case Report A 12-year-old girl was diagnosed with primary alveolar RMS of the breast. Gray scale ultrasound revealed posterior acoustic enhancement behind a well-circumscribed, multilobulated hypoechoic mass. Doppler ultrasound revealed increased peripheral and central vascularity. Hypointense septations on T2-weighted image exhibiting more enhancement than the stroma on late gadolinium-enhanced images were striking within a hyperintense mass. A hyperintense hemorrhagic focus on T1-weighted image was present in the absence of any necrosis. Avid enhancement on early postcontrast images proceeding from the periphery to the center was depicted. Conclusion A rapidly enlarging mass with an echogenic peripheral rim together with posterior acoustic enhancement on gray scale ultrasound, intense vascularity on Doppler ultrasound, axillary lymphadenopathy, and satellite nodules on MRI should raise suspicion. Enhancing central and peripheral septations are suggestive of RMS. Dynamic contrast-enhanced MRI in suspected cases can provide valuable data in the differential diagnosis.
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Affiliation(s)
- Zuhal Bayramoglu
- Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Rejin Kebudi
- Pediatric Hematology-Oncology Section, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.,Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ravza Yilmaz
- Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sema Buyukkapu Bay
- Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Abut Kebudi
- Department of Surgery and Surgical Oncology, School of Medicine, Maltepe University, Istanbul, Turkey
| | - Hasan Karanlik
- Department of Surgery, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Ayca Iribas
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Emin Darendeliler
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bilge Bilgic
- Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Adaletli
- Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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