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Breast diseases in adolescent girls: IGIMS hospital experience.

INTRODUCTION: Breast disorder in the adolescent girls is fortunately uncommon with most lesions turning out to be benign. Breast development is the first sign of puberty in young girls. Breast development during adolescence is an important marker of the transition to adulthood. (1)

Breast development before 8 years is defined as premature, whereas thelarche after 12 years is considered delayed. The grading system elaborated by Tanner is commonly used to classify the normal progression of breast development into 5 stages. (2) However, the spectrum of breast diseases in childhood and adolescence is generally different from that in adults. (3) In contrast to adults, the risk of malignancies of the breast is very low. (4-6) The most important diagnostic imaging method is breast sonography (7,8), which has wide acceptance because of its lack of radiation hazards.

Developmental anomalies or abnormalities of breast can result in poor self--esteem or make the adolescent girl self-conscious. The presentation and diagnosis of breast problems in adolescent girls are discussed in this paper.

MATERIAL AND METHODS: The study population consists of 152 adolescent girls in RB OPD of IGIMS, Patna from Oct, 2010 to March, 2013 of which 48 adolescent girls presented with breast problems. All adolescent girls were clinically examined and assigned a Tanner grade for breast development. A standardized sonographic examination was performed in all the cases. Specific blood tests like thyroid profile and serum prolactin were done as required on individual basis. All patients with confirmed breast abnormalities underwent standardized follow up investigation comprising of clinical examination and sonography, at 3 to 6 month intervals.

OBSERVATION:
Table 1

Presentation of Breast                    n= 48
disorder in Adolescent girls

Painless, movable and firm round lump      20     41.66%
Breast Pain                                10     20.83%
Cyclic Breast Pain                          6     12.50%
Nipple discharge                            2     4.16%
Asymmetry of Breast                         4     8.33%
Breast infection or Abscess                 3     6.25%
Extra Nipple                                1     2.09%
Extra Breast                                1     2.09%
Mammary duct ectasia                        1     2.09%

Table 2

Diagnosis of Breast Disorder                      n=48
in Adolescent

Solid benign tumor n=20                Fibroadenoma (19) Phylloides
(41.66%)                                        tumor (1)

Fibrocystic Breast n=18              Mastalgia (10) Cyclic Mastalgia
(37.50%)                                 (6) Nipple discharge (2)

Developmental disturbance            Macromastia (1) Micromastia (3)
Asymmetry of breast n=4(8.33%)

Breast Abscess or infection                Abscess or Mastitis
n=3(6.25%)

Inherent defect n=2(4.17%)          Accessory Nipple (Axillary & chest
                                  wall) Accessory Breast tissue(Axilla)

Other n=1(2.09%)                           Mammary duct ectasia


RESULT: The clinical and sonographic evaluation confirmed the diagnosis of benign tumors (41.66%), Fibrocystic changes of breast (37.50%), Developmental disturbances (8.33%), Abscess (6.25%), Inherent defect (4.17%) and Mammary duct ectasia (2.09%).

DISCUSSION: Common presenting sign and symptoms in the adolescent patient are breast pain, nipple discharge, and discovery of a mass (9, 10). In the present study Fibroadenoma was present in (39.58%), Fibrocystic changes of breast in (37.5%), Abscess in (6.25%), Inherited defect as Accessory Nipple in (2.09%), Asymmetry of Breast in (8.33%) and Accessory Breast tissue in (2.09%). In one study of all breast masses diagnosed in adolescents, recent retrospective chart reviews demonstrate that approximately 67% are fibroadenoma, 15% are fibrocystic changes of breast, and 3% are abscess or mastitis (11). It is estimated that approximately 25% of adolescent female have breast asymmetry that persist in to adulthood (4). Breast abscesses may occur in adolescent women, particularly if they are lactating. These are managed with antibiotic, drainage using Ultrasonography or drainage in the operating room. Good success has been reported for ultrasonography-guided abscess drainage (12,13). Mastitis in nonlactating adolescents may occur (14). An extra breast (polymastia) or extra nipple (polythelia) occurs in approximately 1% of the population. It may be an inheritable condition (15).

DOI: 10.14260/jemds/2014/2253

REFERENCES:

(1.) De Silva NK, Brandt ML. Disorders of the Breast in children and adolescents, Par 1: Disorders of growth and infections of the Breast. J Pediatr Adoles C Gynecol 2006; 19:345.

(2.) Tanner JM. Growth in Adolescence. 2nd ed. Oxford, England: Blackwell Scientific Publications; 1962.

(3.) Weinstein SP, Conant EF, Orel SG, Zuckerman JA, Bellah R. Spectrum of US findings in pediatric and adolescent patients with palpable breast masses. Radiographics 2000; 20:1613-1621.

(4.) Elsheikh A, Keramopoulos A, Lazaris D, Ambela C, Louvrou N, M ichalas S. Breast tumors during adolescence. Eur J Gynecol Oncol 2000; 21: 408-410.

(5.) Ferguson CM, Powell RW. Breast asses in young women. Arch Surg1989; 124: 1338-1341.

(6.) West KW, Rescorla FJ, Scherer LR III, Grosfeld JL. Diagnosis and treatment of symptomatic breast masses in the pediatric population. J Pediatr Surg 1995; 30:182-187.

(7.) Garcia CJ, Espinoza A, Dinamarca V, et al. Breast US in children and adolescents.Radiographics2000; 20:1605-1612.

(8.) Kronemever KA, Rhee K, Siegel MJ, Sievert L, Hildeboldt CF. Gray scale sonography of breast masses in adolescent girls. J Ultrasound Med 2001; 20:491-496.

(9.) Simmons PS. Breast disorders in adolescent females. Curr Opin Obstet Gynecol 2001; 13:459-61.

(10.) Templeman C, Hertweck SP. Breast disorders in the pediatric and adolescent patient. Obstet Gynecol Clin NORTH Am 2000; 27:19-34.

(11.) Laufer MR, Goldstein DP. The breast: examination and lesions. In: Emans SJ, Laufer MR, Gold stein DP, editors. Pediatric and Adolescent Gynecology. 5th ed. Philadelphia (PA): Lippincott Williams &Wilkins; 2005. P.729-59.

(12.) Ulitzsch D, Nyman MK, Carlson RA. Breast abscess in lactating women: US-guided treatment. Radiology.Sep2004; 232(3):904-9.

(13.) Christensen A F, AL- Suliman N, Nielsen KR, et al. Ultrasound-guided drainage of breast abscesses: results in 151 patients. Br J Radiol.Mar2005; 78(927):186-8.

(14.) Stricker T, Navratil F, Forster I, Hurlimann R, Sennhauser F H. Nonpuerperal mastitis in adolescents. Pediatr. Feb 2006; 148(2):278-81.

(15.) Haagensen CD. Breasts. In: Rubin A, ed. Hand book of congenital Malformation. Philadelphia, Pa: WB Saunders Co; 1967:15-18.

AUTHORS:

1. Dipali Prasad

2. Kalpana Singh

3. Sangeeta Pankaj

4. Manoj Kumar

[5.] Vijayanand Choudary

PARTICULARS OF CONTRIBUTORS:

1. Senior Resident, Department of Reproductive Biology, Indira Gandhi Institute of Medical Sciences, Patna.

2. Assistant Professor, Department of Reproductive Biology, Indira Gandhi Institute of Medical Sciences, Patna.

3. Assistant Professor, Department of Gynaecological Oncology, RCC, Indira Gandhi Institute of Medical Sciences, Patna.

4. Ex. Senior Resident, Department of Gynaecology, Indira Gandhi Institute of Medical Sciences, Patna.

5. Assistant Professor, Department of Pathology, Indira Gandhi Institute of Medical Sciences, Patna.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Sangeeta Pankaj, Assistant Professor, Gynaecological Oncology, RCC, IGIMS. E-mail: sangeetapankaj@yahoo.co.in

Date of Submission: 01/03/2014.

Date of Peer Review: 03/03/2014.

Date of Acceptance: 12/03/2014.

Date of Publishing: 21/03/2014.
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Title Annotation:ORIGINAL ARTICLE
Author:Prasad, Dipali; Singh, Kalpana; Pankaj, Sangeeta; Kumar, Manoj; Choudhary, Vijayanand
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Mar 24, 2014
Words:1114
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