Oncoplastic Approach to Juvenile Giant Fibroadenoma: A Case Series

A giant juvenile fibroadenoma is defined as a fibroadenoma greater than 5 centimeters in size occurring in the pediatric population. It frequently affects adolescents. Rapid growth of the mass may result in breast asymmetry and deformity. Varying techniques in surgical extirpation have been described in order to optimize aesthetics and minimize distortion. The advent of new methods to remove benign breast disease is in its infancy stages. Many practitioners are unaware of the novel options that are emerging in the treatment of fibroadenoma. We describe an excision of a 12 centimeter giant juvenile fibroadenoma and adjacent juvenile fibroadenoma using a strategically atypical incision that resulted in excellent cosmesis and contour of the breast without subsequent reconstruction. Multiple modalities of removing a fibroadenoma are described with a review of the associated risks, benefits, and long term implications as well as a discussion on the indication for reconstructive surgery in patients with giant juvenile fibroadenoma.

Giant fibroadenoma are benign tumors, but there rapid growth and large size may determine difficulties in their work up. We present a case of giant juvenile fibroadenoma of breast in girl of 16 years of age with its diagnostic workup and management. The diagnosis was made on FNAC which was confirmed by Histopathology report. I. Introduction Fibroadenoma is the commonest benign breast disease followed by fibrocystic disease. It implies a new growth pattern comprising of both fibrous and glandular tissue. Fibroadenoma are more common before 30 years of age but can occur at any age group within reproductive period of life. In rare occasions it can show rapid and massive growth resulting in giant fibroadenoma. Giant fibroadenoma are greater than 5 cm in diameter and constitute less than 4% of all fibroadenoma. Giant fibroadenoma may be either adult type or juvenile type. Giant juvenile fibroadenoma is a uncommon tumor presenting in a adolescent female.

Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5–4% of all cases of fibroadenomas. Giant fibroadenomas are rare variants and represent only 0.5% of all fibroadenomas, usually occurring in girls between the ages of 10 and 18. They are characterized by massive and rapid enlargement of a rubbery, mobile, and non-tender mass and defined as being larger than 5 cm or weighing more than 500 g. The aetiology is not well understood and is believed to be an increased sensitivity to normal oestrogen level. We present a 12-year-old Asian girl treated at the age of 8 for idiopathic precocious puberty, without known family history of breast masses or cancers, who developed spontaneous giant fibro-adenoma measuring 15cm X 17 cm. The patient was further evaluated via ultrasonography showing a sole large lesion of 15 X 17 cm in the left breast. Surgical excision with conservation of the developing breast parenchyma and nipple-areolar complex under general anaesthesia was performed. Histopathological findings after the surgical excision were suggestive of juvenile fibroadenoma. The patient has a normal breast development throughout 4 years follow-up. The rapid growth of a breast mass in such young patients can be of great concern causing a considerable impact on these patients’ psychological and emotional condition. One of the most important concerns is the impact on potential future mammary gland development. Therefore, it is crucial to promptly rule out malignant processes or phyllodes tumors and educate young patients and their families on treatment options that fit their concerns. In addition, the final cosmetic result is essential after the surgical excision; although the primary cause of asymmetrical breast enlargement is a benign mass, early surgical excision is efficient concerning the best possible cosmetic outcome. Keywords: Breast mass; juvenile fibroadenoma; giant fibroadenoma.

Introduction: Giant fibroadenoma (GFA) of the breast is defined as fibroadenoma larger than 5 cm, usually presenting unilaterally and manifesting as breast asymmetry or deformity of the breast. Material and Methods: A retrospective database search was done of all patients with giant fibroadenoma who underwent surgery for GFA in the breast center of Hanover Medical School between 2007 and 2014; all patients with GFA were followed up. Data were analyzed with regard to tumor and patient characteristics and esthetic outcome. Results: A total of 13 patients with symptomatic GFA underwent surgery between 2007 and 2014. Mean patient age was 21.2 years (range 14-31 years). In 8 of 13 patients the tumor had resulted in breast deformity and/or breast asymmetry. Average size of the mass was 10.2 cm (range 8.5-12 cm) and average weight was 203.6 g (range 151.2-323.5 g). Initial clinical suspicion of GFA was confirmed by ultrasound examination. Preoperative core biopsy revealed fibroadenoma in 8/13 cases, cellular fibroepithelial lesions with a differential diagnosis of benign phyllodes tumor in 3 cases and unspecific histological findings in the remaining 2 cases. Conclusion: Excision was done using an inframammary or periareolar approach without reconstructive plasty. The cosmetic results were good, as were the outcomes on follow-up. We therefore favor this surgical technique to treat giant fibroadenoma of similar size to those described above.

Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation – A case report

Breast Lumps are not a common occurrence in paediatric patients. When encountered, they call for a thorough workup and meticulous treatment plan. Like in adults, fibroadenomas can be seen in children. These are termed 'juvenile fibroadenomas'. When these are larger than 5cm or weigh more than 500gm, they can be called 'giant juvenile fibroadenomas'. These comprise 1-8% of breast lumps in adolescent population. We report here a case of a 10 years old girl who presented with a rapidly growing unilateral breast lump which provided a diagnostic dielemma but was diagnosed as giant juvenile fibroadenoma on histopathology performed post excision. She was successfully treated surgically by removing the entire well-defined lump intact after raising overlying breast flaps. The post-operative period was uneventful. The patient shows no signs of recurrence or co-morbidity even now at follow up OPD visits.

Breast masses in adolescents are predominantly benign and are most commonly associated with fibroepithelial tumors. These tumors represent a heterogeneous group of biphasic lesions, ranging from benign fibroadenomatoid changes to malignant phyllodes tumors. Differentiating between fibroadenomas and phyllodes tumors is clinically significant owing to their differing malignant potential and the consequent implications for treatment strategies. However, this distinction is often challenging, as the two entities share considerable overlap in both clinical presentation and imaging characteristics. For this reason, surgical excision of the mass followed by histopathological evaluation remains essential to ensure accurate diagnosis and to prevent overlooking malignant forms with metastatic potential. Giant juvenile fibroadenoma, a rare subtype of fibroadenoma, accounts for approximately 0.5-4% of cases in adolescents. Although histologically benign, its characteristic rapid growth frequently necessitates surgical intervention to alleviate symptoms and exclude malignancy. We present the case of a 19‑year‑old female individual of Oromo ethnicity who developed a rapidly enlarging mass in the right breast. Surgical excision was performed, and histopathological evaluation confirmed the diagnosis of giant juvenile fibroadenoma. Giant juvenile fibroadenoma is an uncommon subtype of fibroadenoma, accounting for approximately 0.5-4% of cases in adolescents. It is defined by a tumor weight exceeding 500g, a diameter greater than 5cm, or a mass occupying more than four-fifths of the breast. Characteristically, it demonstrates rapid growth, leading to distortion and compression of the breast parenchyma. Although benign, its aggressive enlargement is particularly observed in children and adolescents. Diagnosis is primarily based on clinical evaluation and imaging studies. Clinically, the lesion presents as a well‑circumscribed, mobile mass with elastic consistency and clear contours, often resulting in breast deformity and aesthetic discomfort. Ultrasonography serves as the principal diagnostic modality, typically revealing a large, homogeneous, hypoechoic lesion. Given its rapid growth, surgical excision is the treatment of choice. Excision is warranted not only to prevent potential damage to the mammary gland but also to address cosmetic concerns and mitigate the negative impact on the patient's quality of life. Although fibroadenomas, benign fibroepithelial lesions, represent the most common breast tumors in children and adolescents, histopathological confirmation remains indispensable to prevent misdiagnosis and to avoid overlooking malignant variants with metastatic potential.

Juvenile fibroadenoma is the most common breast mass in adolescents accounting for 0.5-4% of all cases of fibroadenomas. Giant fibroadenomas are well-circumscribed, firm breast masses characterized by proliferation of epithelial and connective tissue. They are defined as being larger than 5 cm or weighing more than 500 g. The peak age has been reported between the ages of 17 and 20, with less than 5% of these in patients less than 18-years-old.We present a 9-year-old, pre-menstrual, Nigerian female with no known family history of breast masses or cancers who developed spontaneous giant fibroadenoma measuring approximately 13 cm × 13cm. Rapid growth of a breast mass can be of great concern to such young patients whose breasts are in the early formative stages. It is important to promptly rule out malignant processes or phyllodes tumor, and educate young patients and their families on treatment options that fit their unique concerns and circumstances.

Fibroadenoma is the most common benign fibroepithelial lesion of the breast in young women, accounting for around 90% of solid lesions of the gland in adolescence. However, juvenile giant fibroadenoma is a rare breast condition that occurs in women under 18 years of age. Due to the similarity of the characteristics of juvenile giant fibroadenoma and phyllodes tumor, both lesions characterized by rapid growth, it is important to establish the differential diagnosis of both pathologies when one of them is suspected, in order to guarantee the most appropriate therapeutic attitude to follow. A 14-year-old woman with no family or personal history of interest, who consulted due to a clinical picture characterized by breast asymmetry secondary to progressive growth of the left breast of 5 months of evolution. An ultrasound-guided core needle biopsy was performed that reported giant juvenile fibroadenoma. Lumpectomy was performed. Histopathological diagnosis compatible with juvenile giant fibroadenoma of the left breast. Based on our case and on the reviewed bibliography, we recommend an early differential diagnosis, as well as an accurate one, and surgical treatment of cases of juvenile giant fibroadenoma. The surgical tactics and technique depend on the age at the time of diagnosis, the clinical and imaging characteristics of the mammary gland and the tumor, as well as the wishes of the patient in question.

Giant juvenile fibroadenoma: A case report

Juvenile giant fibroadenoma is a rare benign tumour of the breast accounting for 0.5% of all fibroadenomas. The presentation can be very dramatic and may result in breast deformity and...

Importancia del diagnóstico diferencial de los tumores fibroepiteliales mamarios en adolescentes. Descripción de un caso

BACKGROUNDA giant juvenile fibroadenoma (GJF) is a rare, benign breast tumor that affects females < 18 years of age. GJFs are generally suspected based on a palpable mass. GJFs influence breast shape and mammary gland development via the pressure effect from their enormous size.CASE SUMMARYHerein we report a case involving a 14-year-old Chinese female with a GJF in the left breast. GJF is a rare, benign breast tumor that usually occurs between 9 and 18 years of age and accounts for 0.5%-4.0% of all fibroadenomas. In severe cases, breast deformation may occur. This disease is rarely reported in Chinese people and has a high clinical misdiagnosis rate due to the absence of specific imaging features. On July 25, 2022, a patient with a GJF was admitted to the First Affiliated Hospital of Dali University. The preoperative clinical examination and conventional ultrasound diagnosis needed further clarification. The mass was shown to be an atypical lobulated mass during the operation and confirmed to be a GJF based on pathologic examination.CONCLUSIONGJF is also a rare, benign breast tumor in Chinese women. Evaluation of such masses consists of a physical examination, radiography, ultrasonography, computer tomography, and magnetic resonance imaging. GJFs are confirmed by histopathologic examination. Mastectomy is not selected when the patient benefits from a complete resection of the mass with breast reconstruction and an uneventful recovery.

Breast reconstruction using a tissue expander after enucleation of a giant fibroadenoma: A case report

Fibroadenomas are the most common breast masses in adolescent women. Giant fibroadenomas are an uncommon disease during pregnancy and lactation. Significant enlargement might result in breast asymmetry and deformity. We present a rare case of giant fibroadenoma during pregnancy and lactation with significant breast asymmetry. Excision with round block technique leaves a discrete scar and a cosmetic contour.