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      Giant juvenile fibroadenoma of the breast: a case report and brief literature review

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          Abstract

          A girl (age, 12 years 11 months) consulted the pediatric endocrinology clinic because of a rapidly growing right breast mass over 13 cm observed during the preceding 3 months. A surgical excision was performed, and the mass was diagnosed as a giant juvenile fibroadenoma. Giant juvenile fibroadenomas are rare, usually occurring between 10 and 18 years of age, and characterized by massive and rapid enlargement of an encapsulated mass. The etiology is believed to be an end-organ hypersensitivity to normal levels of estrogen. We report a case of giant juvenile fibroadenoma and present a review of the diagnostic workup and management of a large breast tumor during adolescence.

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          Fibroadenomas in adolescence.

          Yasmin Jayasinghe, Cameron P. Simmons (2009)
          Fibroadenomas are the most common breast masses in adolescent women, therefore it is important that health providers understand their assessment and management. This review discusses an approach to investigation and management of fibroadenomas in adolescents. Fibroadenomas are benign tumors which commonly present in late adolescence. They are classified according to their histology and size. Simple fibroadenomas are the most common type and usually present as smooth mobile masses up to 3 cm in diameter. Giant fibroadenomas are more uncommon but typically present in adolescence. Fibroadenomas associated with other soft-tissue masses should raise the possibility of an inherited syndrome. Assessment of breast masses in this age group generally involves clinical assessment through history and physical examination and, when imaging is needed, ultrasonography. As the incidence of primary breast malignancy is very low in this age group, core biopsy is not routinely recommended. Large or rapidly growing tumors, or those associated with suspicious features, warrant surgical excision. New minimally invasive excision techniques are being introduced which are associated with high initial success rates. Whereas the vast majority of fibroadenomas in teenagers may be monitored with surveillance alone, new minimally invasive techniques may play an important role in the management of selected patients.
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            Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision.

            Ian Grady, Heidi Gorsuch, Shelly Wilburn-Bailey (2015)
            Surgical as well as conservative treatment has been described for fibroadenomas. Both have disadvantages. A minimally invasive treatment, ultrasound-guided, vacuum-assisted percutaneous excision has been shown to facilitate the removal of all imaged evidence of benign breast lesions, including fibroadenomas up to 3 cm in diameter. This study is performed to assess the long-term outcome of ultrasound-guided percutaneous excision as a minimally invasive treatment for fibroadenomas. A retrospective review of 69 consecutive fibroadenomas treated with ultrasound-guided percutaneous excision between May, 2001 and December, 2005 was carried out. All these lesions underwent percutaneous excision of all imaged lesion evidence. Clinical and sonographic follow-up was recommended for all patients every 6 months. Initial size, location, and patient age were recorded for each treated lesion. Of 69 lesions treated, 52 were available for follow-up. The median follow-up period was 22 months, with a range of 7 to 59 months. At 6 months, there were no fibroadenoma recurrences. Follow-up sonography demonstrated recurrences in 13 lesions distributed across eight patients. The overall recurrence rate was 15% (8/52) with an actuarial recurrence rate of 33% at 59 months. All of the recurrences were in lesions which were larger than 2 cm in size at initial presentation. Our data suggest that the mechanism of recurrence is the regrowth of retained lesion fragments too small to be detected by ultrasound--not the incomplete excision of all imaged lesion evidence. Despite successful percutaneous excision, fibroadenomas do recur. Lesions smaller than 2 cm in size, so treated, do not need additional therapy or surveillance. Fibroadenomas larger than 2 cm are prone to recurrence and require additional treatment.
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              Breast asymmetry: presentation of a giant fibroadenoma.

              Christopher A Park, Lisa R. David, Louis Argenta (2015)
              Patients often present to plastic surgeons with breast asymmetry of unknown etiology. Many patients are females in late adolescence and present complaining of a hypoplastic breast on the smaller side. However, full evaluation may reveal that the larger breast contains the abnormality. Fibroadenomas typically present as firm, mobile, painless, easily palpable breast nodules. However, giant fibroadenomas can present as unilateral macromastia without definable borders or texture differences. Diagnosis is essential since fibroadenomas tend to persist and grow. However, physical examination and standard radiographic evaluations (mammograms and ultrasounds) fail to clarify the diagnosis in many cases. Magnetic resonance imaging (MRI) has improved preoperative diagnosis, but tissue diagnosis is frequently necessary and resection of giant fibroadenomas is essential as they enlarge to the point of causing psychological detriment or mass effects, including venous congestion, glandular distortion, pressure necrosis, and occasionally ulceration. In this article we review nine patients presenting with unilateral macromastia to a tertiary breast care center with a review of the pertinent literature. The differential diagnosis, evaluation modalities, and treatment options of breast asymmetry and unilateral breast masses are presented. Postexcision breast reconstruction is discussed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Pediatr Endocrinol Metab
                Journal ID (iso-abbrev): Ann Pediatr Endocrinol Metab
                Journal ID (publisher-id): APEM
                Title: Annals of Pediatric Endocrinology & Metabolism
                Publisher: The Korean Society of Pediatric Endocrinology
                ISSN (Print): 2287-1012
                ISSN (Electronic): 2287-1292
                Publication date (Print): March 2014
                Publication date (Electronic): 31 March 2014
                Volume: 19
                Issue: 1
                Pages: 45-48
                Affiliations
                [1 ]Department of Pediatrics, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.
                [2 ]Department of Surgery, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.
                [3 ]Department of Pathology, Korea Institute of Radiological & Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.
                Author notes
                Address for correspondence: Jung Sub Lim, MD, PhD. Department of Pediatrics, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-970-1224, Fax: +82-2-970-2427, limjs@ 123456kcch.re.kr
                Article
                DOI: 10.6065/apem.2014.19.1.45
                PMC ID: 4049547
                PubMed ID: 24926464
                SO-VID: 921461b8-96a1-4d89-9bd9-f90f04d53541
                Copyright © © 2014 Annals of Pediatric Endocrinology & Metabolism
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 December 2013
                Date revision received : 03 March 2014
                Date accepted : 19 March 2014
                Categories
                Subject: Case Report

                Keywords: juvenile gigantomastia,fibroadenoma,breast,adolescent
                Data availability:
                Keywords: juvenile gigantomastia, fibroadenoma, breast, adolescent

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