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Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation

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Abstract

Breast tissue undergoes a series of changes from birth to puberty. The majority of the changes are transient, related to physiological hormonal changes. Although the breast is identical in both sexes at birth, its histology and development will eventually differ. It is important for radiologists to have a basic understanding of endocrinological changes and appearance on imaging to avoid potential pitfalls, particularly on ultrasound, which is the primary modality used to evaluate the breast.

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References

  1. Knell J, Koning JL, Grabowski JE (2016) Analysis of surgically excised breast masses in 119 pediatric patients. Pediatr Surg Int 32:93–96

    Article  PubMed  Google Scholar 

  2. Valeur NS, Rahbar H, Chapman T (2015) Ultrasound of pediatric breast masses: what to do with lumps and bumps. Pediatr Radiol 45:1584–1599

    Article  PubMed  Google Scholar 

  3. García CJ, Espinoza A, Dinamarca V et al (2000) Breast US in children and adolescents. Radiographics 20:1605–1612

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Kaneda HJ, Mack J, Kasales CJ, Schetter S (2013) Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment. AJR Am J Roentgenol 200:W204–W212

    Article  PubMed  Google Scholar 

  6. Expert Panel on Breast Imaging, Moy L, Heller SL et al (2017) ACR appropriateness criteria — palpable breast masses. J Am Coll Radiol 14:S203–S224

    Article  Google Scholar 

  7. Bock K, Duda VF, Hadji P et al (2005) Pathologic breast conditions in childhood and adolescence. J Ultrasound Med 24:1347–1354

    Article  PubMed  Google Scholar 

  8. Greydanus DE, Matytsina L, Gains M (2006) Breast disorders in children and adolescents. Prim Care 33:455–502

    Article  PubMed  Google Scholar 

  9. Eidlitz-Markus T, Mukamel M, Haimi-Cohen Y et al (2010) Breast asymmetry during adolescence: physiologic and non-physiologic causes. Isr Med Assoc J 12:203–206

    PubMed  Google Scholar 

  10. Chang DS, McGrath MH (2007) Management of benign tumors of the adolescent breast Plast Reconstr Surg 120:13e–19e

  11. Howard BA, Gusterson BA (2000) Human breast development. J Mammary Gland Biol Neoplasia 5:119–137

    Article  CAS  PubMed  Google Scholar 

  12. De Silva NK (2018) Breast development and disorders in the adolescent female. Best Pract Res Clin Obstet Gynaecol 48:40–50

    Article  PubMed  Google Scholar 

  13. Lanciotti L, Cofini M, Leonardi A et al (2018) Up-to-date review about minipuberty and overview on hypothalamic-pituitary-gonadal axis activation in fetal and neonatal life. Front Endocrinol (Lausanne) 9:410

    Article  Google Scholar 

  14. Amer A, Fischer H (2009) Images in clinical medicine. Neonatal breast enlargement. N Engl J Med 360:1445

    Article  CAS  PubMed  Google Scholar 

  15. Madlon-Kay DJ (1986) ‘Witch’s milk’: galactorrhea in the newborn. Am J Dis Child 140:252–253

    Article  CAS  PubMed  Google Scholar 

  16. Jawahar A, Vade A (2014) Sonographic features of physiologic neonatal breast enlargement. J Clin Neonatol 3:106–108

    Article  PubMed  PubMed Central  Google Scholar 

  17. Faden H (2005) Mastitis in children from birth to 17 years. Pediatr Infect Dis J 24:1113

    Article  PubMed  Google Scholar 

  18. Stauffer WM, Kamat D (2003) Neonatal mastitis. Pediatr Emerg Care 19:165–166

    PubMed  Google Scholar 

  19. Borders H, Mychaliska G, Gebarski KS (2009) Sonographic features of neonatal mastitis and breast abscess. Pediatr Radiol 39:955–958

    Article  PubMed  Google Scholar 

  20. Al Ruwaili N, Scolnik D (2012) Neonatal mastitis: controversies in management. J Clin Neonatol 1:207–210

    Article  PubMed  Google Scholar 

  21. Quigley CA (2002) Editorial: the postnatal gonadotropin and sex steroid surge — insights from the androgen insensitivity syndrome. J Clin Endocrinol Metab 87:24–28

    CAS  PubMed  Google Scholar 

  22. McHoney M, Munro F, Mackinlay G (2011) Mammary duct ectasia in children: report of a short series and review of the literature. Early Hum Dev 87:527–530

    Article  PubMed  Google Scholar 

  23. McKiernan J, Coyne J, Cahalane S (1988) Histology of breast development in early life. Arch Dis Child 63:136–139

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Welch ST, Babcock DS, Ballard ET (2004) Sonography of pediatric male breast masses: gynecomastia and beyond. Pediatr Radiol 34:952–957

    Article  PubMed  Google Scholar 

  25. Acer T, Derbent M, Hiçsönmez A (2015) Bloody nipple discharge as a benign, self-limiting disorder in young children: a systematic review including two related case reports. J Pediatr Surg 50:1975–1982

    Article  PubMed  Google Scholar 

  26. Nascimento M, Portela A, Espada F, Fonseca M (2012, 2012) Bloody nipple discharge in infancy — report of two cases. BMJ Case Rep 2012:bcr2012006649

  27. Gao Y, Saksena MA, Brachtel EF et al (2015) How to approach breast lesions in children and adolescents. Eur J Radiol 84:1350–1364

    Article  PubMed  Google Scholar 

  28. Ramsey JT, Li Y, Arao Y et al (2019) Lavender products associated with premature thelarche and prepubertal gynecomastia: case reports and endocrine-disrupting chemical activities. J Clin Endocrinol Metab 104:5393–5405

    Article  PubMed  PubMed Central  Google Scholar 

  29. Henley DV, Lipson N, Korach KS, Bloch CA (2007) Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med 356:479–485

    Article  CAS  PubMed  Google Scholar 

  30. Einav-Bachar R, Phillip M, Aurbach-Klipper Y, Lazar L (2004) Prepubertal gynaecomastia: aetiology, course and outcome. Clin Endocrinol 61:55–60

    Article  CAS  Google Scholar 

  31. Jones KN (2013) Imaging of the adolescent breast. Semin Plast Surg 27:29–35

    Article  PubMed  PubMed Central  Google Scholar 

  32. Duflos C, Plu-Bureau G, Thibaud E, Kuttenn F (2012) Breast diseases in adolescents. Endocr Dev 22:208–221

    Article  CAS  PubMed  Google Scholar 

  33. de Vries L, Horev G, Schwartz M, Phillip M (2006) Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol 154:891–898

    Article  PubMed  CAS  Google Scholar 

  34. Youn I, Park SH, Lim IS, Kim SJ (2015) Ultrasound assessment of breast development: distinction between premature thelarche and precocious puberty. AJR Am J Roentgenol 204:620–624

    Article  PubMed  Google Scholar 

  35. Ravichandran D, Naz S (2006) A study of children and adolescents referred to a rapid diagnosis breast clinic. Eur J Pediatr Surg 16:303–306

    Article  CAS  PubMed  Google Scholar 

  36. Kebudi R, Koc BS, Gorgun O et al (2017) Breast metastases in children and adolescents with rhabdomyosarcoma: a large single-institution experience and literature review. J Pediatr Hematol Oncol 39:67–71

    Article  PubMed  Google Scholar 

  37. D’Angelo P, Carli M, Ferrari A et al (2010) Breast metastases in children and adolescents with rhabdomyosarcoma: experience of the Italian soft tissue sarcoma committee. Pediatr Blood Cancer 55:1306–1309

    Article  PubMed  Google Scholar 

  38. Charlot M, Béatrix O, Chateau F et al (2013) Pathologies of the male breast. Diagn Interv Imaging 94:26–37

    Article  CAS  PubMed  Google Scholar 

  39. Chau A, Jafarian N, Rosa M (2016) Male breast: clinical and imaging evaluations of benign and malignant entities with histologic correlation. Am J Med 129:776–791

    Article  PubMed  Google Scholar 

  40. Önder Ö, Azizova A, Durhan G et al (2020) Imaging findings and classification of the common and uncommon male breast diseases. Insights Imaging 11:27

    Article  PubMed  PubMed Central  Google Scholar 

  41. Moore DC, Schlaepfer LV, Paunier L, Sizonenco PC (1984) Hormonal changes during puberty: V. Transient pubertal gynecomastia: abnormal androgen-estrogen ratios. J Clin Endocrinol Metab 58:492–499

    Article  CAS  PubMed  Google Scholar 

  42. Nordt CA, DiVasta AD (2008) Gynecomastia in adolescents. Curr Opin Pediatr 20:375–382

    Article  PubMed  Google Scholar 

  43. Leung AKC, Leung AAC (2017) Gynecomastia in infants, children, and adolescents. Recent Pat Endocr Metab Immune Drug Discov 10:127–137

    Article  PubMed  CAS  Google Scholar 

  44. Draghi F, Tarantino CC, Madonia L, Ferrozzi G (2011) Ultrasonography of the male breast. J Ultrasound 14:122–129

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. 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

    Article  CAS  PubMed  Google Scholar 

  46. Lemaine V, Cayci C, Simmons P, Petty P (2013) Gynecomastia in adolescent males. Semin Plast Surg 27:56–61

    Article  PubMed  PubMed Central  Google Scholar 

  47. Deepinder F, Braunstein GD (2012) Drug-induced gynecomastia: an evidence-based review. Expert Opin Drug Saf 11:779–795

    Article  CAS  PubMed  Google Scholar 

  48. Biro FM, Galvez MP, Greenspan LC et al (2010) Pubertal assessment method and baseline characteristics in a mixed longitudinal study of girls. Pediatrics 126:e583–e590

    Article  PubMed  Google Scholar 

  49. Monaghan P, Perusinghe NP, Cowen P, Gusterson BA (1990) Peripubertal human breast development. Anat Rec 226:501–508

    Article  CAS  PubMed  Google Scholar 

  50. Drife JO (1986) Breast development in puberty. Ann N Y Acad Sci 464:58–65

    Article  CAS  PubMed  Google Scholar 

  51. Javed A, Lteif A (2013) Development of the human breast. Semin Plast Surg 27:5–12

    Article  PubMed  PubMed Central  Google Scholar 

  52. Nuzzi LC, Cerrato FE, Webb ML et al (2014) Psychological impact of breast asymmetry on adolescents: a prospective cohort study. Plast Reconstr Surg 134:1116–1123

    Article  CAS  PubMed  Google Scholar 

  53. 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

    Article  PubMed  Google Scholar 

  54. Bleiziffer S, Schreiber C, Burgkart R et al (2004) The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis. J Thorac Cardiovasc Surg 127:1474–1480

    Article  PubMed  Google Scholar 

  55. Sadove AM, van Aalst JA (2005) Congenital and acquired pediatric breast anomalies: a review of 20 years’ experience. Plast Reconstr Surg 115:1039–1050

    Article  CAS  PubMed  Google Scholar 

  56. Kulkarni D, Dixon JM (2012) Congenital abnormalities of the breast. Womens Health (Lond) 8:75–88

    Article  Google Scholar 

  57. Fokin AA, Robicsek F (2002) Poland’s syndrome revisited. Ann Thorac Surg 74:2218–2225

    Article  PubMed  Google Scholar 

  58. Ferris-James DM, Iuanow E, Mehta TS et al (2012) Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics 32:1009–1030

    Article  PubMed  Google Scholar 

  59. Da Costa D, Taddese A, Cure ML et al (2007) Common and unusual diseases of the nipple-areolar complex. Radiographics 27:S65–S77

    Article  PubMed  Google Scholar 

  60. Wolfswinkel EM, Lemaine V, Weathers WM et al (2013) Hyperplastic breast anomalies in the female adolescent breast. Semin Plast Surg 27:49–55

    Article  PubMed  PubMed Central  Google Scholar 

  61. Warren R, Degnim AC (2013) Uncommon benign breast abnormalities in adolescents. Semin Plast Surg 27:26–28

    Article  PubMed  PubMed Central  Google Scholar 

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Restrepo, R., Cervantes, L.F., Swirsky, A.M. et al. Breast development in pediatric patients from birth to puberty: physiology, pathology and imaging correlation. Pediatr Radiol 51, 1959–1969 (2021). https://doi.org/10.1007/s00247-021-05099-4

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  • DOI: https://doi.org/10.1007/s00247-021-05099-4

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