Almost all of the masses that occur in the prepubertal period are benign. However, the possible diagnoses in children who complain of a mass in the breast are as follows:
- Simple cysts: During childhood, benign simple cysts are mostly seen with the beginning of breast development. These are soft, painless masses that are not fixed to the surrounding breast tissue. Cysts disappear completely with needle aspiration. The fluid is serous or brown. After aspiration, the persistence of the mass is an indication for biopsy.
- Fibrocystic disease: It is a disease of the mature breast. It usually occurs in the 40s-50s. It is not an issue that mostly concerns children.
- Fibroadenoma: It is the most common breast mass in the childhood age group and is known to be benign. There are two types that affect the childhood age group; adult and juvenile.
- Adult fibroadenoma: Affects late adolescents and young women. In 10-15% of cases, the mass is multiple. The mass is small (1-2 cm in diameter). It is well-circumscribed, rubbery and mobile.
- Juvenile fibroadenoma: It affects young adolescents in puberty. Unlike adult fibroadenoma, it is larger and can cause breast asymmetry. Juvenile fibroadenomas should be excised as soon as possible after diagnosis to avoid growth of the mass and preserve the structure of the remaining normal breast tissue. Excision of fibroadenomas is performed directly over the mass with an incision following Langer's lines. The mass that does not contain more than a few millimeters of normal breast tissue is excised. The same approach can be applied for large juvenile fibroadenomas. As a result, breast development is generally normal and symmetrical. The defect created by the tumor is filled over time.
- Phylloid Tumors: Phylloid tumors cystosarcoma phyllodes They are also known as. It varies from a benign tumor to a rapidly growing and metastasizing malignant tumor. The size may be 1-40cm. A massively well-circumscribed phyllodes tumor resembles a fibroadenoma but lacks a true capsule. Small barely noticeable protrusions can be seen on its surface. This unique appearance occurs in normal breast tissue. It requires complete resection with a 2 cm safety margin. Fibrous areas are distributed among soft tissue, muscle areas, and cysts, and the space is filled with clear or semisolid blood fluid. All these appearances allow differentiation from fibroadenoma. The average age of patients is in the forties. Phyllodes tumors can be seen in both adolescence and prepubertal periods. It is difficult to distinguish phyllodes tumors from adenomas before surgery. Definitive diagnosis is made by open excisional biopsy. Although it does not provide a definitive diagnosis in all cases, the diagnosis is determined by seeing a dysmorphic pattern in the stromal and benign epithelial tissue in fine needle aspiration biopsy. The mammographic appearance of phyllodes tumor resembles fibroadenoma. It has a flat, polylobulated appearance. USG is useful when cysts are found without the solid masses characteristic of phyllodes tumor. If the preoperative diagnosis is known, a wide local excision of 2 cm of normal breast tissue should be performed. If the tumor extends to the pectoral fascia, the muscles adjacent to the tumor should also be removed. 20% of phyllodes tumors recur after resection, with minimal or no border. Most authors recommend resection of normal breast tissue to obtain appropriate margins. Benign tumors larger than five cm have a higher recurrence rate than smaller ones (39% and 10%, respectively). Both benign and malignant phyllodes tumors can recur. Malignant histological transformation is observed at a rate of 20% with worse prognosis in recurrences of tumors that were previously resected as benign. Local recurrences of benign tumors are reexcised, although some of the authors recommend simple mastectomy because malignant tumor recurrence may occur.
- Breast Cancer:
- Breast Cancer: strong> Although only 0.2% of all breast cancers occur before the age of 25, breast cancer has been detected in boys younger than 5 years of age as well as in female adolescents. These patients often have nipple discharge. Non-secretory breast cancers are less common in the childhood age group than secretory ones.
- Metastatic carcinomas: Metastatic carcinomas can also be seen in the breast. Breast metastases, especially from osteosarcoma, lymphoma and rhabdomyosarcoma, have been reported.
Treatment method: These masses do not confirm the possible diagnosis. Surgical treatment is required to treat and relieve existing symptoms. This operation will be performed under general anesthesia by a pediatric surgeon. This mass in the breast begins with an incision that fits the skin extensions and falls on the mass (however, your doctor may need to make a different incision), and is completely removed by carefully separating the surrounding important anatomical structures such as vessels, nerves and healthy breast tissue.
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