How are fibroadenomas characterized in pediatric breast disorders?

Updated: Apr 01, 2019
  • Author: Harsh Grewal, MD, FACS, FAAP; Chief Editor: Robert K Minkes, MD, PhD  more...
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Answer

Answer

Breast masses in adolescent girls are usually benign. The most common discrete breast mass is a fibroadenoma (70%). Upon examination, these masses are smooth, mobile, and round (see the images below). They may occasionally become larger just before the patient's menstrual period.  

Fibroadenoma. Ultrasonogram courtesy of Helen Pass Fibroadenoma. Ultrasonogram courtesy of Helen Pass, MD.
Ultrasonogram of fibroadenoma with color Doppler. Ultrasonogram of fibroadenoma with color Doppler. Note lack of vascularity of the lesion. Image courtesy of Brian Coley, MD.
Ultrasonogram of fibroadenoma. Image courtesy of B Ultrasonogram of fibroadenoma. Image courtesy of Brian Coley, MD.

Masses with the characteristics of fibroadenoma may be serially monitored (every 1-3 months) with a careful physical examination. Alternatively, an excisional biopsy may be performed if the patient and family request it. As many as 15% of patients may have multiple fibroadenomas. Studies suggest that fibroadenomas may be treated with US-guided percutaneous radiofrequency ablation (RFA). [13] Complete ablation of the fibroadenoma, as confirmed by follow-up US, occurred in 98% of patients.

Juvenile, or giant, fibroadenomas are unusually large (>5 cm). They usually display rapid growth but are in most cases benign. Management consists of surgery. Histologically, juvenile fibroadenomas have more cellularity than typical fibroadenomas (see the image below). They should be differentiated from phyllodes tumor (cystosarcoma phyllodes).

Hematosin and eosin (H&E) stain of fibroadenoma. I Hematosin and eosin (H&E) stain of fibroadenoma. Image courtesy of Beth A. Trost, MD.

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