Journal of Aesthetic & Reconstructive Surgery ISSN 2472-1905

2017Vol. 3 No.2: 7

iMedPub Journals www.imedpub.com

Case Report

DOI: 10.4172/2472-1905.100030

1© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://aesthetic-reconstructive-surgery.imedpub.com/archive.php

Mehmet Emin Cem Yıldırım1, Sidika Findik2 andZeynep Altuntas1

1 DepartmentofPlastic,ReconstructiveandAestheticSurgery,SchooloftheMedicine,NecmettinErbakanUniversity,Konya,Turkey

2 DepartmentofPathology,SchooloftheMedicine,NecmettinErbakanUniversity,Konya,Turkey

*Corresponding author: ZeynepAltuntas

zeynepkaracor@yahoo.com

Tel: +90 332 223 60 00-7033Fax: +90 332 323 61 81

DepartmentofPlasticandReconstructiveandAestheticSurgery,SchooloftheMedicine,NecmettinErbakanUniversity,42080Meram,Konya,Turkey.

Citation: YıldırımMEC,FindikS,AltuntasZ(2017)ARareCaseofJuvenilGiantFibroadenoma.JAesthetReconstrSurg.Vol.3No.2:7.

IntroductionThemostcommoncauseofbreastmassesseeninyoungwomenis fibroadenomas. It is characterized as benign. Etiologically,increasedestrogenandreceptorsusceptibilityhavebeenaccused[1].Massgrowthusuallystopswhenitreaches2cminsize.Thosewithasizegreaterthan5cmarecalledgiantfibroadenomes[2].Juvenilegiantfibroadenomasareveryrarecasesandconstitute0.5%ofallfibroadenomas.Inthisstudy,wepresenta12-year-oldfemalepatientofgiantjuvenilefibroadenoma.

Case Report12 years old female patient was admitted to our clinic withcomplaints of rapid and excessive growth in her right breast.This complaintshadexisted for2-3months and therewasnotany systemic disease in the history of the patient A painless,circumferentially aligned, mobile mass covering the entire ofboth lower quadrants and upper inner quadrantwas detectedon the breast examination (Figure 1). Her armpit examination

was normal. Other physical examination findings werenormal. Biochemical tests and hormone levels were normal.Ultrasonographic imagingof thepatient revealeda solidmass,that has well defined border, with a heterogeneous structureofvascularbloodvesselsatthe100×65×45mmretroareolarplacement. Magnetic Resonance İmagination (MRI) revealedmasslesionscoveringboththelowerandupperinnerquadrantsofthebreastwhichwashyperintenseandwelldefinedborderinthefat-suppressedT2-weightedseries.

A truecutbiopsywasperformed forpreliminarydiagnosisanddiagnosed as juvenil fibroadenoma. The mass was removedtotally by periareolar incision. We did not made any attemptto providenipple-areola complex symmetry since thepatient'sphysicaldevelopmentcontinued.Therewerenocomplicationsinpostoperativeperiod.HistopathologicdiagnosiswasrevealedaspericanaliculartypeJuvenilgiantfibroadenoma(Figures 2 and 3).Postoperatively,cosmeticappearancewassatisfactory(Figure 4).

Received: August12,2016; Accepted: August22,2017;Published: August30,2017

A Rare Case of Juvenil Giant Fibroadenoma

Figure 1 Preoperativeview.

2017Journal of Aesthetic & Reconstructive Surgery

ISSN 2472-1905 Vol. 3 No. 2: 7

This article is available in: http://aesthetic-reconstructive-surgery.imedpub.com/archive.php2

Discussion and ConclusionGiant juvenile fibroadenomas, composed of epithelium and/orstromaoftheterminallobuleofthebreast,representonly0.5%ofallfibroadenomas[1].Fibroadenomas,whicharewelldefinedborder and encapsulated, grow rapidly as they reach largesizes [3].However, breast asymmetry, nipple irregularities, andcongestionmayoccurwithmasseffect[4]. Inourcase,therewasseriousasymmetryreagrdingthebreastandnipplesize.

Juvenile fibroadenomas usually present during puberty in theage range of 11-18 years and are usually painless lesions [5].The youngest known case in the literature is a 13-month-oldgirl [6]. Todate, there is a lackof specific guidelines regardingtheoptimalmanagementofgiantjuvenilefibroadenomaslikelydue to conflicting diagnostic and treatment strategies. Breastsurgeons, gynecologists, pediatricians, pediatric surgeons andplastic surgeons may encounter giant juvenile fibroadenoma.These patients should be referred to an experienced specialistandamore specificassessmentand treatment strategy shouldbeestablishedonthisissue.

Imagingmethodsshouldbeperformedafterbreastandaxillaryexaminationineverypatientwhocomeswiththemasscomplaintin breast. Mammography is not preferred due to increaseddensities inwomenunder40yearsof age [7]. For this reason,themostcommonmethod isUSG inyoungwomen.SmithandBurrows. found that patients aged 25 and younger suspectedto have a fibroadenoma on ultrasound had 78.8% accuracyin diagnosis based on histology [8]. Obtaining tissue is alsorequiredtodifferentiatebetween juvenilegiantfibroadenomasandphilloidestumors,malignanttumors.Caremustbetakenintermsofmalignancy in thedifferentialdiagnosisandespecially

Figure 2 Preoperativeviewofthemass.

Figure 3 Epithelial proliferative basilaro-cystic ductusstructuresinthecellularstroma(Pericanaliculartypefibroadenoma)(40X).

Figure 4 Postoperativeview.

Vol. 3 No. 2: 7

2017Journal of Aesthetic & Reconstructive Surgery

ISSN 2472-1905

3© Under License of Creative Commons Attribution 3.0 License

phylloides tumors should be considered. Philloides tumor is ararefibroepithelialbreasttumorthataccountsforlessthan1%ofallprimarybreastneoplasms,2-3%ofallfibroepithelial tumors[9,10].Theyaresimilarbenignfibroadenomabutdistinguishedfrom benign fibroadenomas, histologically increased cellularityandclinicallylocalrecurrenceandmetastaticspread.Therefore,the patient who is diagnosed with breast mass should beevaluatedintermsofphysicalexamination,imagingandbiopsy.TherearestudiesintheliteraturethatsuggestthatFineNeedleAspiration (FNA) biopsies are not reliable. one of the largestseriesofover1,400FNAsof adolescentbreastmasses,Kapinaet al. concluded FNA is not required [11]. However, sensitivityof the true-cut biopsy in the literature is reported to be 88-98%,specificity94-100%,andaccuracy93-99%[12,13]. Thus,inourcase,true-cutbiopsywasperformedinsteadoffineneedlebiopsy for tissue obtaining after imaging and histopathologicalpreliminarydiagnosiscameasjuvenilefibroadenoma.

Thetreatmentofjuvenilefibroadenomaisexcisionorobservation.Incasesofsimplefibroadenoma,conservativetreatmentmaybepreferredas10%ofthelesionsspontaneouslyresolve.However,in cases of giant fibroadenomas, surgical treatment should beperformed and additional reconstructive procedures might benecessary.Intheageofpuberty,tumorexcisionandsimultaneousbreast reconstruction principles can be performed to protectthebreastparenchyma,providesymmetryof thenipple-areolacomplexandavoidiatrogenicamastia[11,14].Revisionsurgeriesmaybeneededinordertoprovideacosmeticappearanceaftertheexcisionofthemass. Inourcase,weremovedthemassbyperiareolarincisionandtheremainingbreasttissueintheupperquadrantwassufficienttoprovidethesymmetrywhencomparedtothecounter-breast.However,sincethepatientwasintheageof growth, the possible revision operations for nipple–areolarcomplexsymmetrywerepostponedafterpuberty.

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