An 8-year-old girl is brought to the office due to a breast mass. The mother first noticed the mass when she was helping the patient try on a swimsuit last week. The mass is tender and located on the right side. The patient has no chronic medical conditions. Weight and height are at the 60th and 70th percentile, respectively. Examination shows a tender, firm, 2-cm mass posterior to the right nipple. There is no overlying erythema or axillary lymphadenopathy. Pubic hair development is Tanner stage 1. Which of the following is the most likely diagnosis?

Question

An 8-year-old girl is brought to the office due to a breast mass.  The mother first noticed the mass when she was helping the patient try on a swimsuit last week.  The mass is tender and located on the right side.  The patient has no chronic medical conditions.  Weight and height are at the 60th and 70th percentile, respectively.  Examination shows a tender, firm, 2-cm mass posterior to the right nipple.  There is no overlying erythema or axillary lymphadenopathy.  Pubic hair development is Tanner stage 1.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec25c8_d5f5_90e2_bc81_7596f0a4fe99_MD0003_00 This patient has a unilateral, firm, tender mass posterior to the nipple, which is typical of physiologic thelarche (breast development), the first sign of puberty in most girls. Puberty begins with the pulsatile release of GnRH from the hypothalamus. GnRH stimulates the anterior pituitary to release LH and FSH, which in turn stimulate the ovaries. Increasing estradiol produced by the ovaries in early puberty stimulates the development of breast tissue. In a minority of patients, adrenarche (eg, body odor, pubic hair) precedes thelarche. Pubertal changes in girls typically begin around age 10 and as early as age 8. pulsatile release of GnRH early puberty The first sign of breast development is breast buds, which are characterized by enlargement of the areola, elevation of the papilla, and growth of a small mound of breast tissue. Examination reveals a firm, retroareolar mass that may be slightly tender. Because breast growth is often asymmetric, it is normal for the breast bud to be unilateral in early stages. Patients and families should be reassured that thelarche in girls age ≥8 is normal. Anticipatory guidance regarding the timing of menarche, which is typically 2.5 years after breast development begins, should be provided. (Choice A) Breast fat necrosis typically results from trauma (eg, injury, surgery) and presents as a firm, irregular, nontender mass. This patient has a tender, retroareolar mass with no history of trauma. (Choices B and C) Fibrocystic change is characterized by cyclic, premenstrual, tender breast tissue due to variability in estrogen and progesterone levels. Juvenile fibroadenoma is a firm, mobile, well-circumscribed, nontender mass. Both conditions typically present in the upper outer quadrant of the breast after menarche. (Choice D) Breast lipoma is a subcutaneous, painless, soft tissue mass that usually occurs in women. This patient's age and tender mass make lipoma unlikely. (Choice E) Mammary duct ectasia presents with inflammation of the subareolar milk ducts. Associated findings include nipple discharge, overlying erythema, and nipple inversion, none of which are seen here. Educational objective: Thelarche (typically the first sign of puberty) is normal in girls age ≥8 and is characterized by firm, often tender, breast buds posterior to the nipple. Breast buds can be unilateral in the early stages of puberty. References: Tanner stages. (http://www.ncbi.nlm.nih.gov/pubmed/29262142)

An 8-Year-Old Girl Is Brought to the Office Due to a Breast