Download PDF
Semin Plast Surg 2013; 27(01): 019-022
DOI: 10.1055/s-0033-1343991
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Pediatric and Adolescent Breast Masses

Raelene D. Kennedy
1   Department of Surgery, Mayo Clinic, Rochester, Minnesota
,
Judy C. Boughey
1   Department of Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
23 May 2013 (online)

Also available at
    Permissions and Reprints

Abstract

Breast masses in children and adolescents are uncommon and most often benign. Occasionally, however, they require surgical intervention for lifestyle limiting symptoms or malignant potential. These masses are best evaluated with physical exam and ultrasound. Breast masses likely to be encountered by the surgeon in the pediatric and adolescent population include intraductal papillomas, phyllodes tumors, primary breast cancer, and metastatic lesions. Unlike adults, pediatric and adolescent breast cancer tends to be of the secretory variety and typically have less metastatic potential. However, cases of inflammatory and medullary breast cancers have also been reported in girls and appear more aggressive. Radiation exposure during breast development is a risk factor to subsequent development of breast cancer. Surgical objective for a concerning pediatric and adolescent breast mass is complete resection while preserving normal breast development, when appropriate. The need for routine axillary dissection for malignant cases in children appears unnecessary from the limited data available, and the authors favor sentinel lymph node sampling and reserve axillary dissection for positive lymph nodes.

Keywords

pediatric - breast cancer - phyllodes - intraductal papilloma - surgery
 

  • References

  • 1 Neinstein LS, Atkinson J, Diament M. Prevalence and longitudinal study of breast masses in adolescents. J Adolesc Health 1993; 14 (4) 277-281
    CrossrefPubMedGoogle Scholar
  • 2 Simmons PS, Jayasinghe YL, Wold LE, Melton III LJ. Breast carcinoma in young women. Obstet Gynecol 2011; 118 (3) 529-536
    CrossrefPubMedGoogle Scholar
  • 3 Jayasinghe Y, Simmons PS. Breast disorders in the female. In: Fisher MM, Alderman EM, Kreipe RE, Rosenfeld WD, , eds. Textbook of Adolescent Health Care. Elk Grove Village, IL: American Academy of Pediatrics; 2011: 621-634
    Google Scholar
  • 4 Bobo JK, Lee NC, Thames SF. Findings from 752,081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 2000; 92 (12) 971-976
    CrossrefPubMedGoogle Scholar
  • 5 Pruthi S, Jones KN, Boughey JC, Simmons PS. Breast masses in adolescents: clinical pearls in the diagnostic evaluation. Am Fam Physician 2012; 86 (4) 325-326
    PubMedGoogle Scholar
  • 6 Weinstein SP, Conant EF, Orel SG, Zuckerman JA, Bellah R. Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics 2000; 20 (6) 1613-1621
    CrossrefPubMedGoogle Scholar
  • 7 De Silva NK, Brandt ML. Disorders of the breast in children and adolescents, Part 2: breast masses. J Pediatr Adolesc Gynecol 2006; 19 (6) 415-418
    CrossrefPubMedGoogle Scholar
  • 8 Greydanus DE, Parks DS, Farrell EG. Breast disorders in children and adolescents. Pediatr Clin North Am 1989; 36 (3) 601-638
    PubMedGoogle Scholar
  • 9 Fallat ME, Ignacio Jr RC. Breast disorders in children and adolescents. J Pediatr Adolesc Gynecol 2008; 21 (6) 311-316
    CrossrefPubMedGoogle Scholar
  • 10 Rosen PP. Papillary duct hyperplasia of the breast in children and young adults. Cancer 1985; 56 (7) 1611-1617
    CrossrefPubMedGoogle Scholar
  • 11 Wilson M, Cranor ML, Rosen PP. Papillary duct hyperplasia of the breast in children and young women. Mod Pathol 1993; 6 (5) 570-574
    PubMedGoogle Scholar
  • 12 Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J 2001; 77 (909) 428-435
    CrossrefPubMedGoogle Scholar
  • 13 Alabassi A, Fentiman IS. Sarcomas of the breast. Int J Clin Pract 2003; 57 (10) 886-889
    PubMedGoogle Scholar
  • 14 Chao TC, Lo YF, Chen SC, Chen MF. Sonographic features of phyllodes tumors of the breast. Ultrasound Obstet Gynecol 2002; 20 (1) 64-71
    CrossrefPubMedGoogle Scholar
  • 15 Chang DS, McGrath MH. Management of benign tumors of the adolescent breast. Plast Reconstr Surg 2007; 120 (1) 13e-19e
    CrossrefPubMedGoogle Scholar
  • 16 West KW, Rescorla FJ, Scherer III LR, Grosfeld JL. Diagnosis and treatment of symptomatic breast masses in the pediatric population. J Pediatr Surg 1995; 30 (2) 182-186 , discussion 186–187
    CrossrefPubMedGoogle Scholar
  • 17 Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ, Souba WW. Surgical management of phyllodes tumors. Arch Surg 1999; 134 (5) 487-492 , discussion 492–493
    CrossrefPubMedGoogle Scholar
  • 18 Neinstein LS. Breast disease in adolescents and young women. Pediatr Clin North Am 1999; 46 (3) 607-629
    CrossrefPubMedGoogle Scholar
  • 19 Shannon C, Smith IE. Breast cancer in adolescents and young women. Eur J Cancer 2003; 39 (18) 2632-2642
    CrossrefPubMedGoogle Scholar
  • 20 Murphy JJ, Morzaria S, Gow KW, Magee JF. Breast cancer in a 6-year-old child. J Pediatr Surg 2000; 35 (5) 765-767
    CrossrefPubMedGoogle Scholar
  • 21 Ramirez G, Ansfield FJ. Carcinoma of the breast in children. Arch Surg 1968; 96 (2) 222-225
    CrossrefPubMedGoogle Scholar
  • 22 Nonomura A, Kimura A, Mizukami Y , et al. Secretory carcinoma of the breast associated with juvenile papillomatosis in a 12-year-old girl. A case report. Acta Cytol 1995; 39 (3) 569-576
    PubMedGoogle Scholar
  • 23 Serour F, Gilad A, Kopolovic J, Krispin M. Secretory breast cancer in childhood and adolescence: report of a case and review of the literature. Med Pediatr Oncol 1992; 20 (4) 341-344
    CrossrefPubMedGoogle Scholar
  • 24 Eskelinen M, Vainio J, Tuominen L, Vihko R, Klemi P, Collan Y. Carcinoma of the breast in children. Z Kinderchir 1990; 45 (1) 52-55
    PubMedGoogle Scholar
  • 25 Chamadol W, Pesie M, Puapairoj A. Inflammatory carcinoma of the breast in a 12-year-old Thai girl. J Med Assoc Thai 1987; 70 (9) 543-548
    PubMedGoogle Scholar
  • 26 Ferguson Jr TB, McCarty Jr KS, Filston HC. Juvenile secretory carcinoma and juvenile papillomatosis: diagnosis and treatment. J Pediatr Surg 1987; 22 (7) 637-639
    CrossrefPubMedGoogle Scholar
  • 27 Karl SR, Ballantine TV, Zaino R. Juvenile secretory carcinoma of the breast. J Pediatr Surg 1985; 20 (4) 368-371
    CrossrefPubMedGoogle Scholar
  • 28 Rosen PP, Lyngholm B, Kinne DW, Beattie Jr EJ. Juvenile papillomatosis of the breast and family history of breast carcinoma. Cancer 1982; 49 (12) 2591-2595
    CrossrefPubMedGoogle Scholar
  • 29 Massé SR, Rioux A, Beauchesne C. Juvenile carcinoma of the breast. Hum Pathol 1981; 12 (11) 1044-1046
    CrossrefPubMedGoogle Scholar
  • 30 Rosen PP, Cantrell B, Mullen DL, DePalo A. Juvenile papillomatosis (Swiss cheese disease) of the breast. Am J Surg Pathol 1980; 4 (1) 3-12
    CrossrefPubMedGoogle Scholar
  • 31 Tavassoli FA, Norris HJ. Secretory carcinoma of the breast. Cancer 1980; 45 (9) 2404-2413
    CrossrefPubMedGoogle Scholar
  • 32 Heydenrych JJ, Villet WT, von der Heyden U. Carcinoma of the breast in children: a case report and review of the literature. S Afr Med J 1980; 57 (24) 1005-1008
    PubMedGoogle Scholar
  • 33 Byrne MP, Fahey MM, Gooselaw JG. Breast cancer with axillary metastasis in an eight and one-half-year-old girl. Cancer 1973; 31 (3) 726-728
    CrossrefPubMedGoogle Scholar
  • 34 Oberman HA, Stephens PJ. Carcinoma of the breast in childhood. Cancer 1972; 30 (2) 470-474
    CrossrefPubMedGoogle Scholar
  • 35 Simpson JS, Barson AJ. Breast tumours in infants and children: a 40-year review of cases at a children's hospital. Can Med Assoc J 1969; 101 (2) 100-102
    PubMedGoogle Scholar
  • 36 McDivitt RW, Stewart FW. Breast carcinoma in children. JAMA 1966; 195 (5) 388-390
    CrossrefPubMedGoogle Scholar
  • 37 Feig SA. Radiation risk from mammography: is it clinically significant?. AJR Am J Roentgenol 1984; 143 (3) 469-475
    CrossrefPubMedGoogle Scholar
  • 38 Guyer PB, Dewbury KC. Sonomammography in benign breast disease. Br J Radiol 1988; 61 (725) 374-378
    CrossrefPubMedGoogle Scholar
  • 39 Tanimura A, Konaka K. Carcinoma of the breast in a 5 years old girl. Acta Pathol Jpn 1980; 30 (1) 157-160
    PubMedGoogle Scholar
  • 40 Nichini FM, Goldman L, Lapayowker MS, Levy WM, Maier W, Rosemond GP. Inflammatory carcinoma of the breast in a 12-year-old girl. Arch Surg 1972; 105 (3) 505-508
    CrossrefPubMedGoogle Scholar
  • 41 Lipitt WH, Medart Jr WS, Ramsey SN. Breast cancer in a 10-year-old girl. Surgery 1970; 68 (2) 395-396
    PubMedGoogle Scholar
  • 42 Farrow JH, Ashikari H. Breast lesions in young girls. Surg Clin North Am 1969; 49 (2) 261-269
    PubMedGoogle Scholar
  • 43 Close MB, Maximov NG. Carcinoma of the breast in young girls. Arch Surg 1965; 91: 386-389
    CrossrefPubMedGoogle Scholar
  • 44 Hammar B. Childhood breast carcinoma: report of a case. J Pediatr Surg 1981; 16 (1) 77-78
    CrossrefPubMedGoogle Scholar
  • 45 Teasdale C, Baum M. Breast cancer in a schoolgirl. Lancet 1976; 2 (7986) 627
    PubMedGoogle Scholar
  • 46 Ashley S, Royle GT, Corder A , et al. Clinical, radiological and cytological diagnosis of breast cancer in young women. Br J Surg 1989; 76 (8) 835-837
    CrossrefPubMedGoogle Scholar
  • 47 Dehner LP, Hill DA, Deschryver K. Pathology of the breast in children, adolescents, and young adults. Semin Diagn Pathol 1999; 16 (3) 235-247
    PubMedGoogle Scholar
  • 48 Rogers DA, Lobe TE, Rao BN , et al. Breast malignancy in children. J Pediatr Surg 1994; 29 (1) 48-51
    CrossrefPubMedGoogle Scholar
  • 49 Chateil JF, Arboucalot F, Pérel Y, Brun M, Boisserie-Lacroix M, Diard F. Breast metastases in adolescent girls: US findings. Pediatr Radiol 1998; 28 (11) 832-835
    CrossrefPubMedGoogle Scholar
  • 50 Gold DG, Neglia JP, Dusenbery KE. Second neoplasms after megavoltage radiation for pediatric tumors. Cancer 2003; 97 (10) 2588-2596
    CrossrefPubMedGoogle Scholar
  • 51 Saslow D, Boetes C, Burke W , et al; American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007; 57 (2) 75-89
    CrossrefPubMedGoogle Scholar