Giant Juvenile Fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report

Abstract

Introduction: Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5-2% of all fibroadenomas.

Presentation of case: In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan.

Discussion: Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases.

Conclusion: The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility.

Keywords: Benign breast lump; Giant fibroadenoma; Juvenile fibroadenoma; Sub-areolar excision.

Fig. 1

A large mass occupying the entire left breast causing its significant enlargement with stretching and outward displacement of nipple areola complex and prominent superficial veins.

Fig. 2

(A,B): Pre-operative skin markings comparing level of NAC along with the incision mark at upper medial aspect and a sliver of skin (oblique lines) which was removed in an attempt to centralize the NAC.

Fig. 3

(A) Gross appearance of tumor showing well circumscribed, smooth and slightly bosselated outer surface and (B) tan white, firm, lobulated cut surface.

Fig. 4

(A) Low power view of the tumor showing a fibroepithelial lesion surrounded by thin fibrous capsule at the periphery. The stromal component is dominant and it shows pericanalicular growth pattern. (B) High power view showing epithelial hyperplasia and stromal cells lacking nuclear atypia and increased mitoses.

Fig. 5

(A) Appearance of breasts at 2 weeks follow up showing regression of skin elasticity and a near normal appearance of left breast. (B) At 1 year follow-up with excellent cosmetic outcome.