Background: Pediatric patients may be referred for breast imaging for a number of reasons, including palpable masses. Breast masses within the pediatric population are uncommon but can be a significant source of stress for patients and families. The vast majority of pediatric and adolescent breast masses are benign and unlikely to require surgical intervention. Ultrasound is the mainstay of imaging the pediatric breast when necessary. Image-guided biopsies in adolescents should be carefully considered given the risk of injury to the developing breast. Therefore, recognition of imaging features of pediatric breast masses and correlation with clinical exam is paramount to diagnosis and management. Because much of training in breast imaging focuses on the adult population, radiologists should familiarize themselves with the spectrum of pediatric breast pathology, especially the benign and malignant masses that are uncommon in pediatric populations. Though extremely rare, malignant breast masses can occur in children.
Learning Objectives: 1. Explore how the diagnostic approach to the pediatric breast differs from that of the adult. 2. Review pathophysiology and imaging features of uncommon pediatric breast masses, both benign and malignant. 3. Discuss management of uncommon pediatric breast masses, and the clinical and imaging features that may prompt tissue sampling.
Abstract Content/Results: This pictorial review of uncommon benign and malignant pediatric breast masses discusses the following cases: - Ductal ectasia - Juvenile fibroadenoma - Pseudoangiomatous stromal hyperplasia (PASH) - Mondor disease - Poland syndrome - Hemangioma - Galactocele - Intraductal papilloma - Phyllodes tumor - Invasive ductal carcinoma - Metastatic disease to the breast
Each case includes a discussion of management and how incidence, evaluation and management may differ from that of adults.
Conclusion: Because breast malignancy is exceedingly rare in children, management of pediatric breast pathology is often more conservative than that of adult breast pathology. Clinical exam and ultrasound are the most important tools in diagnosis of pediatric breast masses; mammography is almost never used. Imaging follow-up in lieu of tissue sampling is emphasized when appropriate in order to prevent iatrogenic injury to the developing breast. As such, familiarity with clinical and imaging presentation of uncommon pediatric breast masses can help prevent unneeded interventions.
