El Graini Soumya, El Hassouni Fatima, Rouas Lamia, Fathi Khalid, Chat Latifa, El Haddad Siham
Radiology Department, Women and Children Hospital - Ibn Sina University Hospital, University Mohamed V, Rabat, Morocco.
Department of Gyneco-Obstetrics-High-Risk Pregnancy-Cancerology, Souissi Maternity Hospital of Rabat, University Mohamed V, Rabat, Morocco.
Int J Surg Case Rep. 2024 Aug;121:109897. doi: 10.1016/j.ijscr.2024.109897. Epub 2024 Jun 12.
Breast pathology in adolescents is rare and predominantly benign, with abnormalities including congenital anomalies, infections, mastodynia, nipple discharge, and mostly benign breast masses. Fibroepithelial tumors, the most common type, form a heterogeneous group that includes benign, borderline, and malignant entities such as phyllodes tumors. Differentiation of these tumors, especially various types of fibroadenomas, requires histopathological examination due to their similar radiological appearances and lesion heterogeneity. Recognizing the nature of these lesions is crucial to avoid missing malignant forms with metastatic potential. Giant juvenile fibroadenoma is a quite rare benign fibroepithelial tumour, that cannot be differentiate from phyllodes tumors before anatomopathological examination.
We report the case of a 14-year-old patient who presented with a rapidly enlarging mass in the left breast, and the diagnosis of giant juvenile adenofibroma was confirmed after surgical treatment.
Giant juvenile fibroadenomas occurs in adolescent girl and constitutes 0.5 % - 4 % of all fibroadenomas cases. When it exceeds 5 cm, weighs more than 500 g, or occupies more than 4/5 of the breast, it is considered as giant. It is characterized by a rapid increase in size, causing distortion and compression of the breast. Breast ultrasound is the first imaging modality, showing a large, well-limited hypo or iso echoic mass. The main differential diagnosis should be made with phyllodes tumors. The diagnosis is considered based on clinical and radiological features but is confirmed only after surgical excision of the mass and histological study.
The discovery of a breast mass in an adolescent should prompt further investigations to avoid overlooking a fibroepithelial tumour. The most probable diagnoses are giant juvenile fibroadenoma and phyllodes tumors.
青少年乳腺病变较为罕见，且多为良性，异常情况包括先天性畸形、感染、乳腺疼痛、乳头溢液，以及大多为良性的乳腺肿块。纤维上皮性肿瘤是最常见的类型，它是一个异质性群体，包括良性、交界性和恶性实体，如叶状肿瘤。由于这些肿瘤的放射学表现相似且病变具有异质性，因此对其进行鉴别，尤其是各种类型的纤维腺瘤，需要进行组织病理学检查。认识这些病变的性质对于避免漏诊具有转移潜能的恶性形式至关重要。巨大型幼年性纤维腺瘤是一种非常罕见的良性纤维上皮性肿瘤，在解剖病理学检查之前无法与叶状肿瘤区分开来。
我们报告了一名14岁患者的病例，该患者左乳出现迅速增大的肿块，手术治疗后确诊为巨大型幼年性腺纤维瘤。
巨大型幼年性纤维腺瘤发生于青春期女孩，占所有纤维腺瘤病例的0.5% - 4%。当其直径超过5厘米、重量超过500克或占据乳腺超过4/5时，被视为巨大型。其特点是大小迅速增加，导致乳腺变形和受压。乳腺超声是首选的影像学检查方法，显示为一个大的、边界清晰的低回声或等回声肿块。主要的鉴别诊断应与叶状肿瘤进行。诊断基于临床和放射学特征，但只有在肿块手术切除并进行组织学研究后才能确诊。
青少年发现乳腺肿块应促使进一步检查，以避免忽视纤维上皮性肿瘤。最可能的诊断是巨大型幼年性纤维腺瘤和叶状肿瘤。
