Spectrum of US Findings in Pediatric and Adolescent Patients with Palpable Breast Masses1
Susan P. Weinstein, MD,
Emily F. Conant, MD,
Susan G. Orel, MD,
Julia A. Zuckerman, MD and
Richard Bellah, MD
1 From the Department of Radiology, Division of Breast Imaging, University of Pennsylvania Medical Center, 1 Silverstein Bldg, 3400 Spruce St, Philadelphia, PA 19104 (S.P.W., E.F.C., S.G.O., J.A.Z.); and the Department of Radiology, Children's Hospital of Philadelphia, Pa (R.B.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1999 RSNA scientific assembly. Received March 21, 2000; revision requested April 14 and received May 31; accepted June 1. Address correspondence to S.P.W.
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Figure 1a. Tanner stages of breast development. (a) Stage I, preadolescent, the nipple elevates. (b) Stage II, the breast bud develops. The breast tissue and nipple arise as a single mound of tissue. (c) Stage III, the single mound enlarges. (d) Stage IV, a secondary mound develops, with the nipple and areola projecting above the breast tissue. (e) Stage V, the areola regresses to form a smooth contour with the rest of the breast tissue.
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Figure 1b. Tanner stages of breast development. (a) Stage I, preadolescent, the nipple elevates. (b) Stage II, the breast bud develops. The breast tissue and nipple arise as a single mound of tissue. (c) Stage III, the single mound enlarges. (d) Stage IV, a secondary mound develops, with the nipple and areola projecting above the breast tissue. (e) Stage V, the areola regresses to form a smooth contour with the rest of the breast tissue.
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Figure 1c. Tanner stages of breast development. (a) Stage I, preadolescent, the nipple elevates. (b) Stage II, the breast bud develops. The breast tissue and nipple arise as a single mound of tissue. (c) Stage III, the single mound enlarges. (d) Stage IV, a secondary mound develops, with the nipple and areola projecting above the breast tissue. (e) Stage V, the areola regresses to form a smooth contour with the rest of the breast tissue.
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Figure 1d. Tanner stages of breast development. (a) Stage I, preadolescent, the nipple elevates. (b) Stage II, the breast bud develops. The breast tissue and nipple arise as a single mound of tissue. (c) Stage III, the single mound enlarges. (d) Stage IV, a secondary mound develops, with the nipple and areola projecting above the breast tissue. (e) Stage V, the areola regresses to form a smooth contour with the rest of the breast tissue.
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Figure 1e. Tanner stages of breast development. (a) Stage I, preadolescent, the nipple elevates. (b) Stage II, the breast bud develops. The breast tissue and nipple arise as a single mound of tissue. (c) Stage III, the single mound enlarges. (d) Stage IV, a secondary mound develops, with the nipple and areola projecting above the breast tissue. (e) Stage V, the areola regresses to form a smooth contour with the rest of the breast tissue.
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Figure 2. Developing breast bud mistaken for a right breast mass in an 8-year-old girl. US scan shows breast tissue in the subareolar location (*) that is hypoechoic relative to the fat (straight arrow). The pectoralis muscle (curved arrow) lies posterior to the fat.
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Figure 3a. Premature thelarche in a 7-month-old female infant. US scans of the right (a) and left (b) breasts show tissue in the subareolar regions. Development of the breast buds is asymmetric, greater in a than in b. In a, * indicates the pectoralis muscle, and the arrow indicates a rib. Premature thelarche is a benign condition that usually manifests in the first 2 years of life. There should be no other associated signs of secondary sexual characteristics.
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Figure 3b. Premature thelarche in a 7-month-old female infant. US scans of the right (a) and left (b) breasts show tissue in the subareolar regions. Development of the breast buds is asymmetric, greater in a than in b. In a, * indicates the pectoralis muscle, and the arrow indicates a rib. Premature thelarche is a benign condition that usually manifests in the first 2 years of life. There should be no other associated signs of secondary sexual characteristics.
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Figure 4. Breast US scan in a healthy 5-month-old female infant shows the subcutaneous fat as mildly heterogeneous.
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Figure 5. Asymmetric breast development in a 9-year-old girl. US scans of both breasts show tissue in the subareolar regions bilaterally, more prominent on the left side (L) than on the right side (R). Asymmetric development was mistaken for a left breast mass at clinical examination.
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Figure 6. Normal breast US scan in an 11-year-old girl. Fat, which is hypoechoic, is interrupted by linear echogenic planes of connective tissue.
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Figure 7. Normal breast US scan in a 17-year-old girl. Glandular tissue (*), which is echogenic, is surrounded by hypoechoic fat.
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Figure 8a. Gynecomastia in an 11-year-old boy. (a) US scan directly over the palpable area in the left breast shows hypoechoic tissue in the subareolar region. (b) US scan of the right breast shows a similar appearance, although the hypoechoic tissue is less prominent. Findings are suggestive of bilateral gynecomastia.
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Figure 8b. Gynecomastia in an 11-year-old boy. (a) US scan directly over the palpable area in the left breast shows hypoechoic tissue in the subareolar region. (b) US scan of the right breast shows a similar appearance, although the hypoechoic tissue is less prominent. Findings are suggestive of bilateral gynecomastia.
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Figure 9. Simple cyst in a palpable area in the left breast in a 15-year-old girl. US scan shows a 15-mm-diameter anechoic simple cyst with additional smaller adjacent cysts.
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Figure 10. Fibroadenoma in an 18-year-old woman who presented with a newly palpable breast mass in the right breast. US scan reveals a well-circumscribed oval hypoechoic mass. Diagnosis was made with core needle biopsy.
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Figure 11a. Fibroadenoma in a 10-year-old girl. (a) US scan of the left breast shows a solid homogeneous mass. (b) Gadolinium-enhanced MR image of the same breast reveals a mass with internal septations consistent with a giant fibroadenoma, which was confirmed at excisional biopsy. A second smaller fibroadenoma is located inferior to the palpable one. Given the size of the first mass, the differential diagnosis would include juvenile fibroadenoma and cystosarcoma phyllodes.
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Figure 11b. Fibroadenoma in a 10-year-old girl. (a) US scan of the left breast shows a solid homogeneous mass. (b) Gadolinium-enhanced MR image of the same breast reveals a mass with internal septations consistent with a giant fibroadenoma, which was confirmed at excisional biopsy. A second smaller fibroadenoma is located inferior to the palpable one. Given the size of the first mass, the differential diagnosis would include juvenile fibroadenoma and cystosarcoma phyllodes.
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Figure 12. Small palpable lymph node in the left breast in a 15-year-old girl. US scan obtained directly over the palpable area shows an 8-mm-long hypoechoic mass with an echogenic center. Although the lymph node is small, its superficial location made it easy to palpate.
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Figure 13a. Palpable galactocele in a 19-year-old woman 4 months after giving birth. US scans of the left breast show a complex mass spanning 5.5 cm. There also were multiple dilated tubular structures filled with echogenic material representing dilated milk-filled ducts. Given the clinical history and imaging findings, the complex mass was believed to be a galactocoele. The patient subsequently underwent aspiration, which yielded milky fluid.
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Figure 13b. Palpable galactocele in a 19-year-old woman 4 months after giving birth. US scans of the left breast show a complex mass spanning 5.5 cm. There also were multiple dilated tubular structures filled with echogenic material representing dilated milk-filled ducts. Given the clinical history and imaging findings, the complex mass was believed to be a galactocoele. The patient subsequently underwent aspiration, which yielded milky fluid.
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Figure 14. Duct ectasia in the right breast in a 13-year-old girl. US scan depicts anechoic tubular structures.
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Figure 15. Breast abscess in a 19-year-old woman with a tender palpable area in the right breast and clinical signs and symptoms of an infection. US scan shows a superficial fluid collection with debris. Surgical incision and drainage were performed.
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Copyright © 2000 by the Radiological Society of North America.
