Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_62
© Springer International Publishing Switzerland 2014
Breast Nodules
(1)
Department of General Surgery, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 21-70, Danville, PA 17822, USA
Abstract
The majority of the breast masses in children are benign. However, when a breast mass is found in a child or adolescent, it often causes anxiety in patients and their parents. In prepubertal children, most common cause is unilateral or bilateral thelarche, which does not require any treatment. Breast nodules in adolescents will be discussed here.
Breast nodules: The majority of the breast masses in children are benign. However, when a breast mass is found in a child or adolescent, it often causes anxiety in patients and their parents. In prepubertal children, most common cause is unilateral or bilateral thelarche, which does not require any treatment. Breast nodules in adolescents will be discussed here.
1.
Pathophysiology:
(a)
Fibrocystic change:
(i)
More than 50 % of women in reproductive age experience fibrocystic changes.
(ii)
It is thought to result from an imbalance between estrogen and progesterone.
(b)
Fibroadenoma:
(i)
These are the most common breast lesions in adolescents.
(ii)
They are composed of fibrous and glandular tissue.
(iii)
It is very rare that fibroadenomas progress to malignancy.
(c)
Mastitis:
(i)
Mastitis and breast abscesses are more common in infants younger than two months old than in children or adolescents.
(ii)
Mastitis occurs in the same frequency in girls and boys in their first two weeks of age.
(iii)
Mastitis is twice as common in girls than in boys after two weeks of age.
(iv)
This is possibly due to the longer duration of physiologic breast hypertrophy in females.
(v)
In older children or adolescents, it occurs less frequently.
(vi)
Possible causes are trauma (nipple piercing, plucking periareolar hair, shaving or manipulation of breast tissue during sexual activity), obesity, skin infection, mammary ectasia or epidermoid cysts.
(vii)
Staphylococcus aureus is the most common pathogen.
(d)
Phyllodes tumor:
(i)
These are rare tumors of the breasts. They are mostly found in middle-aged women but can be found in children as young as 10-years-old.
(ii)
It contains two types of breast tissue: Stromal (connective) tissue and glandular (lobule and duct) tissue.
(iii)
It can be classified as benign (85–90 %), malignant (10–15 %) or borderline.
(iv)
Benign tumors have a tendency to grow aggressively and can recur locally.
(v)
Less than 5 % metastasizes and can metastasize to the lung, mediastinum and skeleton.
2.
Clinical presentation:
(a)
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Fibrocystic change:
(i)
It is painful breast tissue before menses and improves during menstruation.
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