J Korean Soc Radiol.  2013 Feb;68(2):141-151. 10.3348/jksr.2013.68.2.141.

Common and Uncommon Conditions of Breast Disease in Children and Adolescents: A Pictorial Review

• Cho H
• Kim KS
• Kim DM
• Kim YM
• Kim HH

• KMID: 2097992
• DOI: http://doi.org/10.3348/jksr.2013.68.2.141

Abstract

The purpose of this study is to review various breast diseases in children and adolescents and to illustrate the sonographic findings. We reviewed the cases at our institution in order to identify breast disease in children and adolescent patients who underwent sonography and mammography. Breast disease in children and adolescents included developmental disturbance, infection, benign tumors and inherent defects. In contrast to adults, the radiologic findings of malignant breast conditions in pediatric populations have rarely been reported; however, we show ductal carcinoma in situ with juvenile fibroadenoma and rhabdomyosarcoma. During childhood and adolescence, the recognition and correct identification of physiologic breast development and specific lesions in breast entities on radiologic findings is most helpful in identifying and characterizing abnormalities and in guiding further investigation.

MeSH Terms

Adolescent
Adult
Breast
Breast Diseases
Carcinoma, Intraductal, Noninfiltrating
Child
Fibroadenoma
Humans
Mammography
Rhabdomyosarcoma

Figure

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  Fig. 1 Premature thelarche, 2-year-old female baby who presented with prominent both breasts. A, B. Sonogram (A, B) shows bilateral development of fibroglandular tissue at the subareolar area and there is no evidence of discrete lesion. This findings are typical premature thelarche. HAND simple radiography and pelvis sonography was normal.

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  Fig. 2 Unilateral nodular gynecomastia, right breast, 17-year-old boy. A. Longitudinal sonogram shows a retroareolar discoid hypoechoic area surrounding by fatty tissue at the right breast. B. Sonogram shows normal left breast.

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  Fig. 3 Bilateral dendritic gynecomastia, 13-year-old boy. Transverse sonogram shows a retroareolar hypoechoic lesion, which may appear irregular finger-like projections at the both breasts.

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  Fig. 4 Fibroadenoma, 12-year-old girl who presented with right breast lump. Sonogram shows the well-circumscribed oval shaped, iso-to-hypoechoic mass. Histology was fibroadenoma undertaken by ultrasonography guided core biopsy.

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  Fig. 5 Juvenile fibroadenoma, 14-year-old girl who presented with asymmetric left breast enlargement. A. Simple chest radiography shows asymmetric huge left breast mass (arrows). B. Sonogram shows the hyperechoic septation (arrowhead) and smaller anechoic cleft (arrow) within a huge, well-circumscribed, fairly uniform hypoechogenic mass. Histology was juvenile fibroadenoma undertaken by excisional biopsy.

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  Fig. 6 Cancer in situ with fibroadenoma, 18-year-old girl who presented with left palpable mass. Sonogram shows the round, macrolobulated mass with heterogenous echogenicity. Mammotome biopsy was done. Histology showed a juvenile fibroadenoma with focally irregular border and florid ductal hyperplasia. It was recommended to excise the mass completely. Excision was done 6 months later. Pathologic confirmation was ductal carcinoma in situ with a juvenile fibroadenoma with microcalcification.

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  Fig. 7 Benign phyllodes tumor, 15-year-old girl who presented with both rubbery breast masses. A, B. Sonogram shows the well-circumscribed oval shaped, hypoechoic masses at the left (A) and right (B) breast. Sonogram (left and right) are similar to the appearance of a juvenile fibroadenoma. But, histology showed benign phyllodes tumor at the left breast and juvenile fibroadenoma at the right.

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  Fig. 8 Fibrocystic change, 17-year-old girl. Sonogram shows a lobulating contoured, well marginated, predominantly hypoechoic mass with some internal echogenic foci.

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  Fig. 9 Mastitis and abscess, a female baby at postnatal age of 14 days who presented with fever and erythematous breast. A. Sonogram shows a well-circumscribed, ovoid shaped, heterogeneously hypoechoic lesion at the left subareolar area. Needle aspiration was done and S. aureus was found. B. Follow up sonogram shows a markedly decreased extent of the lesion after antibiotic treatment during 50 days.

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  Fig. 10 Epidermoid cyst, 14-year-old girl who presented with a small movable left breast lump. Sonogram shows a well-circumscribed, ovoid shaped, predominantly hypoechoic mass with heterogeneous internal echotexture and no internal vascularity that is superficial in location. Ultrasound-guided core biopsy was undertaken. Histology showed an epidermoid cyst.

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  Fig. 11 Cystic lymphangioma, 18-year-old boy who presented with swelling of left axilla. A. Chest radiograph shows a asymmetric left axillary swelling (arrows). B, C. Contrast-enhanced CT scan shows a low-attenuated localized lobulating multiseptated cystic mass with septal wall enhancement in the left lateral chest wall and axilla, along the neurovascular bundle. There is no evidence of enhancing solid portion in the mass or no evidence of bony destruction. D, E. Coronal T1-weighted (D) and T2-weighted (E) MR image shows a cystic mass with multiple septa (arrows). Histology showed cystic lymphangioma taken by excisional biopsy.

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  Fig. 12 Fibrolipoma, 6-year-old girl who presented with right breast lump. Sonogram shows the well-circumscribed oval shaped, heterogenous hyperchoic mass.

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  Fig. 13 Fat necrosis, 16-year-old boy who presented with right chest wall palpable mass after having minor blunt trauma by a soccer ball. A. Sonogram shows an encapsulated, well-circumscribed, beaded shaped, heterogenously isoechoic lesion at the right subareolar area. There is no breast parenchymal tissue. Sonography guided core biopsy (14 G automated gun) was undertaken and histology showed fat necrosis with fibroconnective tissue. B. Color Doppler image shows no internal vascularity with the lesion.

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  Fig. 14 Rhabdomyosarcoma, 21-year-old women. A. Sonogram shows a huge, irregular shape, indistinct marginated heterogenous hypoechoic mass in left breast lower inner quadrant. B. MR image shows multifocal infiltrating, ill-defined mass with intermediate signal intensity on T1 weighted image and high signal intensity on T2 weighted image (not shown). Post-contrast enhanced MR image shows ring-like enhancing mass with early rapid contrast enhancement and delayed washout. Histology showed embryonal type of rhabdomyosarcoma.

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