Chung Ellen M, Cube Regino, Hall Gregory J, González Candela, Stocker J Thomas, Glassman Leonard M
Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
Radiographics. 2009 May-Jun;29(3):907-31. doi: 10.1148/rg.293095010.
The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.
儿童和青少年乳腺病变的范围与成人有显著差异，前者的病变绝大多数是良性的。年轻男孩或女孩的乳腺肿块可能源于正常和异常的乳腺发育。肿块的其他原因包括感染、创伤和囊肿形成。青春期开始后，女孩乳腺增大的大多数病例源于良性纤维腺瘤，男孩则源于男性乳腺增生。这些情况有特定的影像学表现，尽管青少年（通常为巨大型）纤维腺瘤与叶状肿瘤无法区分，而叶状肿瘤可能是良性的也可能是恶性的。在儿童中，这两种情况在超声检查中通常表现为边界清晰的低回声肿块，在磁共振成像中除了无强化的分隔外均表现为弥漫性强化。幼年乳头状瘤病（一种良性病变）的诊断预示着日后患乳腺癌的可能性，患有这种疾病的患者应密切监测。儿童乳腺恶性病变很少见。最常见的恶性病变是转移瘤，通常与广泛的疾病相关。最常见的原发性乳腺恶性肿瘤是恶性叶状肿瘤。原发性乳腺癌在儿童年龄组中极为罕见，但其在儿童中的影像学表现与成人相同，且与几乎所有良性病变不同。对于女孩，诊断性干预可能会损伤发育中的乳腺并导致后续的畸形。鉴于这种风险以及该人群中恶性疾病的低患病率，在乳腺病变的诊断中应遵循谨慎的原则。影像学检查结果对于选择进一步诊断程序的患者非常有帮助。尽管恶性病变很少见，但具有可疑影像学表现或进行性生长的病变应进行细胞学或组织学检查。
