FRONTIERS IN MEDICAL CASE REPORTS - Volume 5; Issue 6, (Nov-Dec, 2024)
Pages: 01-03
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Paediatric Breast Fibroadenoma
Author: Temitope Busari, Monica Patil, Motahare Yadegarfar, Bhavna Batohi, Saira Haque
Category: Medical Case Reports
Abstract:
A breast fibroadenoma is a painless, unilateral, benign tumour that presents as a solid mass. This case report discusses the clinical presentation and management of breast fibroadenoma in a 6 year old girl. We highlight the role of using a multidisciplinary team approach to optimise care.
Keywords: Breast Fibroadenoma, Benign Tumour
Full Text:
Clinical History
A 6-year-old girl with a painful right breast lump which had previously grown slowly over a year but there had been more rapid growth over the last 2 months. On clinical examination the lump was mobile, firm, and tender. She had achieved pubarche, but not menarche. The mass was clinically indeterminate and the patient was referred for ultrasound imaging.
Imaging Findings
The patient underwent ultrasound (US) examination which revealed a well-circumscribed hypoechoic solid mass measuring 6 cm (Fig. 1). The mass demonstrated benign appearances of being wider than tall, no fluid clefts, no spiculated margins or posterior acoustic shadowing. Based on these findings the differential diagnoses were fibroadenoma or phyllodes tumour.

Figure 1
Discussion
Fibroadenomas are the most common benign breast lesions which are derived from the terminal duct lobular unit (Eleftheriades et al., 2023). These lesions are usually asymptomatic and on clinical examination felt as mobile, well circumscribed masses. On US, fibroadenomas are mostly homogeneous and hypoechoic and can demonstrate posterior acoustic shadowing (Namazi et al., 2017).
As described above, the mass in this patient demonstrated benign features: wider than tall, central vascularity, no fluid clefts, no spiculated margins or posterior acoustic shadowing. Following imaging the differentials were narrowed to a giant fibroadenoma (>5 cm) and phyllodes tumour (Namazi et al., 2017). There were no fluid clefts characteristic of a phyllodes tumour and as such the most likely diagnosis is fibroadenoma. Biopsy was withheld, as in paediatric patients, this is not recommended unless the mass has atypical features (Sanders et al., 2018).
The case was discussed in a multidisciplinary meeting with the breast surgical team. The plan was to follow up twice at 6 monthly intervals alternating between the breast surgeon and the paediatrician. The decision was made to withhold biopsy as the ultrasound findings were benign and to avoid deformity of the developing breast. However at clinical follow up, the mass was progressively increasing in size and a biopsy confirmed that it was a fibroadenoma, with subsequent surgical removal.
Conclusion
The key learning points were that ultrasound helped characterise a clinically indeterminate mass. Paediatric breast disease is overwhelmingly benign so characterisation on ultrasound and follow-up to monitor rapid or significant changes after a baseline scan is helpful.
References:
Eleftheriades A, Tsarna E, Toutoudaki K, Paschalidou E, Christopoulos N, Georgopoulos I, Mitropoulou G, Christopoulos P. Giant Juvenile Fibroadenoma: Case Report and Review of the Literature. J Clin Med 2023; 12: 1855.
Namazi A, Adibi A, Haghighi M, Hashemi M. An Evaluation of Ultrasound Features of Breast Fibroadenoma. Adv Biomed Res 2017; 6: 153.
Sanders LM, Sharma P, El Madany M, King AB, Goodman KS, Sanders AE. Clinical breast concerns in low-risk pediatric patients: practice review with proposed recommendations. Pediatr Radiol 2018; 48: 186-195.
Tian J, Liu X, Chen Q. Giant fibroma of breast in an adolescent female by inverted" T" incision: A case report and literature review. Cent South Univ 2020; 45: 204-207.
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