Abstract
The approach to breast masses in children differs from that in adults in many ways, including the differential diagnostic considerations, imaging algorithm and appropriateness of biopsy as a means of further characterization. Most pediatric breast masses are benign, either related to breast development or benign neoplastic processes. Biopsy is rarely needed and can damage the developing breast; thus radiologists must be familiar with the imaging appearance of common entities so that biopsies are judiciously recommended. The purpose of this article is to describe the imaging appearances of the normally developing pediatric breast as well as illustrate the imaging findings of a spectrum of diseases, including those that are benign (fibroadenoma, juvenile papillomatosis, pseudoangiomatous stromal hyperplasia, gynecomastia, abscess and fat necrosis), malignant (breast carcinoma and metastases), and have variable malignant potential (phyllodes tumor).
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Kaneda HJ, Mack J, Kasales CJ et al (2013) Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment. AJR Am J Roentgenol 200:W204–W212
West KW, Rescorla FJ, Scherer LR III et al (1995) Diagnosis and treatment of symptomatic breast masses in the pediatric population. J Pediatr Surg 30:182–187
Chung EM, Cube R, Hall GJ et al (2009) From the Archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics 29:907–931
Osborne MP, Boolbol SK (2014) Breast anatomy and development. In: Harris JR, Lippman ME, Morrow M, Osborne CK (eds) Diseases of the breast, 5th edn. Lippincott Williams & Wilkins, Philadelphia, pp 3–5
Weinstein SP, Conant EF, Orel SG et al (2000) Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics 20:1613–1621
García CJ, Espinoza A, Dinamarca V (2000) Breast US in children and adolescents. Radiographics 20:1605–1612
Venta LA, Dudiak CM, Salomon CG et al (1994) Sonographic evaluation of the breast. Radiographics 14:29–50
Baker JA, Soo MS, Rosen EL (2001) Artifacts and pitfalls in sonographic imaging of the breast. AJR Am J Roentgenol 176:1261–1266
Tanner JM (1962) Growth at Adolescence: with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity, 2nd edn. Blackwell Scientific Publications, Oxford
Marshall WA, Tanner JM (1969) Variations in pattern of pubertal changes in girls. Arch Dis Child 44:291–303
Calcaterra V, Sampaolo P, Klersy C et al (2009) Utility of breast ultrasonography in the diagnostic work-up of precocious puberty and proposal of a prognostic index for identifying girls with rapidly progressive central precocious puberty. Ultrasound Obstet Gynecol 33:85–91
Nicholson BT, Harvey JA, Cohen MA (2009) Nipple-areolar complex: normal anatomy and benign and malignant processes. Radiographics 29:509–523
Amaranathan A, Balaguruswamy K, Bhat RV et al (2013) An ectopic breast tissue presenting with fibroadenoma in axilla. Case Rep Surg 2013:947295
Cuenca RE (2004) Breast anatomy and development. In: Ganschow P (ed) Breast health and common breast problems: a practical approach. American College of Physicians, Philadelphia, pp 3–14
Welch ST, Babcock DS, Ballard ET (2004) Sonography of pediatric male breast masses: gynecomastia and beyond. Pediatr Radiol 34:952–957
Goldman RD (2010) Drug-induced gynecomastia in children and adolescents. Can Fam Physician 56:344–345
Lattin GE Jr, Jesinger RA, Mattu R et al (2013) From the radiologic pathology archives: diseases of the male breast: radiologic-pathologic correlation. Radiographics 33:461–489
Nguyen C, Kettler MD, Swirsky ME et al (2013) Male breast disease: pictorial review with radiologic-pathologic correlation. Radiographics 33:763–779
Dialani V, Baum J, Mehta TS (2010) Sonographic features of gynecomastia. J Ultrasound Med 29:539–547
Kronemer KA, Rhee K, Siegel MJ et al (2001) Grayscale sonography of breast masses in adolescent girls. J Ultrasound Med 20:491–496
Sabate JM, Clotet M, Torrubia S et al (2007) Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics 27:S101–S124
Soo MS, Kornguth PJ, Hertzberg BS (1998) Fat necrosis in the breast: sonographic features. Radiology 206:261–269
Bilgen IG, Ustun EE, Memis A (2001) Fat necrosis of the breast: clinical, mammographic and sonographic features. Eur J Radiol 39:92–99
Glazebrook KN, Morton MJ, Reynolds C (2005) Vascular tumors of the breast: mammographic, sonographic, and MRI appearances. AJR Am J Roentgenol 184:331–338
Sanchez R, Ladino-Torres MF, Bernat JA et al (2010) Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings. Pediatr Radiol 40:1681–1689
Patterson SK, Jorns JM (2013) A case of juvenile papillomatosis, aka ‘Swiss cheese disease’. Breast J 19:440–441
Gill J, Greenall M (2007) Juvenile papillomatosis and breast cancer. J Surg Educ 64:234–236
AlSharif S, Meguerditchian A, Omeroglu A et al (2015) Pilomatricoma of the male breast: sonographic mammographic MRI features with pathologic correlation. Clin Imaging 39:308–310
Szántó J, András C, Tsakiris J et al (2004) Secretory breast cancer in a 7.5-year old boy. Breast 13:439–442
Gutierrez JC, Housri N, Koniaris LG et al (2008) Malignant breast cancer in children: a review of 75 patients. J Surg Res 147:182–188
Howarth CB, Caces JN, Pratt CB (1980) Breast metastases in children with rhabdomyosarcoma. Cancer 46:2520–2524
Kim SM, Park JM (2003) Computed tomography of the breast. Abnormal findings with mammographic and sonographic correlation. J Comput Assist Tomogr 27:761–770
Martino A, Zamparelli M, Santinelli A et al (2001) Unusual clinical presentation of a rare case of phyllodes tumor of the breast in an adolescent girl. J Pediatr Surg 36:941–943
Cecen E, Uysal KM, Harmancıoglu O et al (2008) Phyllodes tumor of the breast in an adolescent girl. Pediatr Hematol Oncol 25:79–82
Yabuuchi H, Soeda H, Matsuo Y et al (2006) Phyllodes tumor of the breast: correlation between MR findings and histologic grade. Radiology 241:702–709
Calhoun KE, Allison KH, Kim JN et al (2014) Phyllodes tumors. In: Harris JR, Lippman ME, Morrow M, Osborne CK (eds) Diseases of the breast, 5th edn. Lippincott Williams & Wilkins–Wolters Kluwer Health, Philadelphia
Kennedy RD, Boughey JC (2013) Management of pediatric and adolescent breast masses. Semin Plast Surg 27:19–22
McDivitt RW, Stewart FW (1966) Breast carcinoma in children. JAMA 195:388–390
Wang Y-Q, Wang Y, Zhang J-H et al (2014) Secretory breast carcinoma in a 12-year-old girl: a case report. Oncol Lett 8:1635–1637
Bond SJ, Buchino JJ, Nagaraj HS (2004) Sentinel lymph node biopsy in juvenile secretory carcinoma. J Pediatr Surg 39:120–121
Mendelson EB, Böhm-Vélez M, Berg WA et al (2013) ACR BI-RADS® Ultrasound. In: ACR BI-RADS® atlas, breast imaging reporting and data system. American College of Radiology, Reston
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This article was awarded the John Caffey Award for Best Educational Poster at the Society for Pediatric Radiology 2014 meeting.
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Valeur, N.S., Rahbar, H. & Chapman, T. Ultrasound of pediatric breast masses: what to do with lumps and bumps. Pediatr Radiol 45, 1584–1599 (2015). https://doi.org/10.1007/s00247-015-3402-0
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DOI: https://doi.org/10.1007/s00247-015-3402-0