BREAST DISEASES IN CHILDREN

The patient is examined in detail for other signs of puberty. Menstruation, genital pubic hair growth etc. situations are questioned. If menstruation is occurring, whether it is regular or not, when was the last menstrual period, the beginning of the complaints and the presence of breast disease in the family are questioned.

The existence of a known hormonal disorder or chronic disease is learned. If necessary, the patient is referred to the pediatric endocrinology clinic.

• PHYSICAL EXAMINATION:

Deformity of the breasts, edema, redness, skin and breast Pay attention to whether there is any recession in the head. The presence of a palpable mass in the breast is investigated in sitting and lying positions.

The area under the armpit and above the collarbone is evaluated for the presence of enlarged lymph nodes.

• HOW IS THE DIAGNOSIS?

The most helpful tests in clarifying the diagnosis after the physical examination are:

Ultrasonography: Is the mass solid? It is clear whether it is cystic or not. Failure to detect masses and calcifications smaller than 5 mm creates difficulties in early diagnosis. It is a noninvasive examination that is easy to access, inexpensive, and does not contain radiation. It is the most frequently used diagnostic tool in the follow-up of childhood breast diseases.

Mammography: Soft tissue and calcification within it. It is an examination that shows the It is not recommended for use in childhood due to its radiation effect.

Fine needle aspiration: It is the process of taking a sample from the mass by passing through the skin with a needle attached to a syringe. If the mass is cystic, the fluid is drained and laboratory and cytological examinations are performed. However, it should be kept in mind that a negative cytological examination does not eliminate the possibility of breast cancer. However, studies have shown that benign masses are seen more frequently, especially in childhood, so they are recommended in the differential diagnosis. False negative and false positive results are low. It does not require general anesthesia and is a fast and safe diagnostic method.

Breast biopsy: Needle aspiration biopsy is performed incisional for suspicious masses that grow during clinical examination and follow-up, or excisional biopsy for smaller masses. Due to breast deformities that may occur after surgery in children, it is applied to patients with strong suspicion of malignancy.

• MAJOR BREAST DISEASES:

Politelia: The presence of one or more extra nipples anywhere in the milk line from the armpit to the pubis.

Polymastia (accessory breast): It means having more than two breasts. It can be located in the area from the armpit to the pubis. Nipple may also be present. It can often be confused with lymph node enlargement, sebaceous gland and sweat gland diseases. Its frequency has been reported as 2-6%. It is twice as common in women than in men. Although it is most common in the armpit, there is a risk of developing benign and malignant diseases as in the normal breast. 0.3% of all breast cancers occur in accessory breast tissue. Due to the low risk, follow-up is recommended rather than surgical treatment. yesterday It is recommended that patients regularly self-examine and undergo medical examination. Depending on the age of the patient, ultrasonography and mammography are the tests used in follow-up. There are also patients who underwent surgery for cosmetic reasons.

Hypoplasia and Aplasia: It is the underlying anomaly in the chest wall structure. It may be accompanied by absence or decrease in volume involving the pectoral muscles or ribs. Breast tissue is underdeveloped or underdeveloped.

Atrophy: It is the shrinkage or disappearance of breast tissue after normal breast development. Endocrine disorders resulting from low estrogen or increased androgen in adolescents may be responsible. It may also occur after excessive weight loss.

Fat necrosis: It is a benign condition that mimics breast cancer. It is believed to occur as a result of breast trauma.

Mastitis and Abscesses: There may be pain, redness and swelling in the breast upon application. Appropriate antibiotic treatment is recommended. If an abscess is suspected, drainage should be done.

Mastalgia: Pain in the breast. It may be related to the menstrual cycle or independent of it. Its frequency in young and adolescent girls is unknown. It can continue for a long time. It disappears spontaneously in half of the patients. Various medical treatments may be recommended.

Ductal ectasia:It is a rare pathology in children and is manifested by a mass under the nipple or bloody nipple discharge. Its frequency in children has been reported to be 2.5 times higher in men. Physical examination and ultrasonography are sufficient for diagnosis. Single or multiple cystic lesions under the nipple can be seen with ultrasonography. However, autopsy studies have shown enlargement of the breast ducts in children between the ages of 3 weeks and 3 years with no breast disease or symptoms. That's why your breast Although it is accepted that it is a developmental anomaly, its cause has not been fully elucidated. Its treatment is controversial. It has been shown that nipple discharge usually disappears between 1-9 months. Surgical treatment is another choice for lesions that are visible to the eye and palpable on manual examination, especially in boys.

Gynecomastia: It is the benign proliferation of the glandular tissue in the male breast. The breast has become large enough to be seen or felt. Physiologically, male breast enlargement can be seen in the neonatal period, adolescence and old age. Gynecomastia is seen in 30-60% of boys. It first appears at the age of 10-12. The most common period is 13-14 years of age. Usually no treatment is needed. Follow-up is recommended. If it persists for more than 1 year, additional investigation is required. It is recommended that patients be directed to the endocrine clinic, to rule out hormonal disorders, to question chronic drug use, and to examine testicles and adrenal glands in terms of neoplasia.

• BREAST DISEASES IN NEWBORN BABIES:

In term babies, there is a nodule in the breast with a diameter of approximately 1 cm. This continues until infancy and disappears. Milk may come from the newborn baby's breast due to hormones passed from the mother. It usually goes away on its own within 3-4 weeks. Rarely, pain may continue for up to 6 months. This is a normal situation. Rarely, benign conditions such as periductal mastitis, nipple changes and nipple retraction may be encountered during infancy.

• PREPPUBERTAL BREAST MASSES:

Patients of both genders, more commonly in girls, may present with complaints of a palpable breast mass, deformity, nipple discharge, breast pain, swelling, and redness. There may be a difference of months between the development of both breast buds. This is a normal situation.

• BREAST CYSTS-FIBROCYSTIC DISEASE:

Cysts may form in the breast during the development phase. They are generally benign formations that are painless, soft and not attached to surrounding tissues. Very large cysts can be emptied with a needle and sent for cytological examination.

Fibrocystic disease can also be a cause of pain in the breast, often during the menstrual cycle. Menstrual irregularity may often accompany it. It disappears spontaneously within a few cycles. If it persists, diagnostic and therapeutic interventions may be required.

• FIBROADENOM:

They are the most common formations in the breast in childhood. Its frequency has been reported as 7-13%. 0.5-2% of these are giant fibroadenomas, they are over 5 cm and weigh more than 500 mg. They are usually 1-2 cm in size and occur more than once in 10-15% of patients. They are benign formations. The risk of developing severe disease has been reported as 0.3%. The data on this subject are controversial in the literature, and while there are those who report that the frequency of developing breast cancer later in patients with fibroadenoma is increased compared to similar patients, there are also those who argue that the frequency is equal. Fibroadenomas are well circumscribed, rubbery and mobile. It is recommended to remove it with clean surgical margins in cases that are over 2 cm or over 1 cm and continue to grow during follow-up. 10-40% of it disappears spontaneously. Despite this, even after surgical removal, the probability of recurrence within 5 years of follow-up has been reported as 33%.

• IS BREAST CANCER SEEN IN CHILDREN?

Malignant breast diseases are rare in children. Its frequency has been reported to be less than 0.1% in 100 thousand women under the age of 20.

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