Contributed by: Steven J. Rockoff, MD and Diana L. Lam, MD – June 1, 2020
Question 1
A 15-year old girl visits her doctor because she is concerned about a right breast mass that seems to be quickly growing.
What is the most appropriate test for her doctor to order?
A. Diagnostic ultrasound
B. Diagnostic mammogram
C. Diagnostic tomosynthesis
D. Diagnostic MRI
Answer
A. Diagnostic ultrasound
Explanation: For any female under the age of 30 presenting with a presenting breast mass, the first imaging exam that should be obtained is a diagnostic ultrasound. Due to the increased risk of ionizing radiation, the increased likelihood of extremely dense tissue, and the low incidence of breast cancer in this demographic, mammography is not the appropriate first imaging exam to utilize in this situation.
Question 2
The ultrasound was performed. Representative images of the dominant abnormality are shown here:
This mass measures up to 65 mm in longest axis. What is the most likely diagnosis?
A. Granular cell tumor
B. Juvenile fibroadenoma
C. Hemangioma
D. Invasive ductal carcinoma
Answer
B. Juvenile fibroadenoma
Explanation: Fibroadenoma, a benign fibroepithelial lesion, is the most common breast mass in the pediatric population. Juvenile fibroadenoma, also known as giant fibroadenoma, is a variant characterized by rapid growth to a size of 5 cm or larger. Like normal fibroadenomas, they are usually circumscribed round or oval masses. Biopsy is usually indicated because the potentially malignant Phyllodes tumor can have an identical imaging appearance. Because of their rapid growth and their potential to cause local deformity, they are usually treated with surgical excision.
The other answer choices are possible pediatric breast masses, but are not as common as fibroadenoma.