What Caused This Breast Lump?

April 30, 2010

A 16-year-old girl has had a left breast lump for 6 months that recently became tender. Except for several small nodules in both breasts and tenderness of the lateral left breast, physical findings are normal and the patient is otherwise healthy.

THE CASE: A 16-year-old girl has had a left breast lump for 6 months that recently became tender. Except for several small nodules in both breasts and tenderness of the lateral left breast, physical findings are normal and the patient is otherwise healthy. The mother is highly concerned that her daughter has breast cancer because her maternal grandmother died of the disease. A sonogram of the left breast is shown.

Answer on the Next Page

Fibroadenoma is the correct answer.

The ultrasonographic finding of a well-defined, hypoechoic, homogeneous, oval mass measuring about 20 to 30 mm in diameter (in this case, 16 × 20 × 7 mm) is consistent with a fibroadenoma.1 This benign neoplasm is the most common cause of an adolescent breast mass. In various studies, fibroadenomas account for about 60% to 90% of breast tumors diagnosed either surgically or sonographically in adolescents.2-5

Typically, a fibroadenoma is not painful; however, some patients have tenderness. Although fibroadenomas frequently present as a solitary lesion that remains stable or shrinks over time,6 they can be multiple and bilateral. Half of fibroadenomas resolve within 5 years; the resolution rate is much higher in women 20 years and younger.7

Evaluation of an adolescent breast mass usually consists of watchful waiting. Reexamination after 1 or 2 menstrual cycles is recommended, because many benign lesions will begin to resolve during that time. When certain factors, such as worrisome systemic symptoms or heightened parental or patient concern, warrant definitive diagnosis, breast ultrasonography, fine-needle aspiration, core biopsy, or excisional biopsy can be used.8 Sonomammography, in particular, has been shown to be effective in the evaluation of breast masses in young patients.9,10

Although an adolescent breast lump can signal cancer (predominantly secondary or metastatic lesions),11 this diagnosis is unlikely in patients who lack atypical ultrasonographic findings associated with malignancy,12 systemic symptoms, and axillary lymphadenopathy. A breast abscess or mastitis would present with signs of infection, such as breast warmth, erythema, edema, discharge, fever, chills, malaise, and axillary lymphadenopathy-all of which were absent in this patient.

Case and image courtesy of Melinda N. Cooper, MD, and Linda S. Nield, MD, of West Virginia University School of Medicine in Morgantown.

References:

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