A 16-year-old girl comes to the office with a breast lump that she discovered 2 days ago while applying lotion. Menarche was at age 12 and menstrual periods are regular, occurring approximately every 30 days. Her last menstrual period was about 1 month ago. The patient has a history of atopic dermatitis that typically flares during the summer and with exercise. She also has asthma for which she takes albuterol as needed. She takes no other medications and has no allergies. Her immunizations are up to date. The patient drinks alcohol and smokes marijuana 2-3 times per week. She does not use tobacco or other drugs. Her maternal aunt is in remission after metastatic breast cancer, which was diagnosed at age 55. Physical examination shows a rubbery, 4-cm mass in the superior outer quadrant of the left breast. Which of the following findings is most likely to be expected in this patient?

Question

A 16-year-old girl comes to the office with a breast lump that she discovered 2 days ago while applying lotion.  Menarche was at age 12 and menstrual periods are regular, occurring approximately every 30 days.  Her last menstrual period was about 1 month ago.  The patient has a history of atopic dermatitis that typically flares during the summer and with exercise.  She also has asthma for which she takes albuterol as needed.  She takes no other medications and has no allergies.  Her immunizations are up to date.  The patient drinks alcohol and smokes marijuana 2-3 times per week.  She does not use tobacco or other drugs.  Her maternal aunt is in remission after metastatic breast cancer, which was diagnosed at age 55.  Physical examination shows a rubbery, 4-cm mass in the superior outer quadrant of the left breast.  Which of the following findings is most likely to be expected in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c145_a54d_8f63_152d2810f891_MD0005_00 Fibroadenoma is the most common cause of a palpable breast mass in adolescents. Characteristic physical findings include a single, rubbery, mobile, well-circumscribed mass in the upper outer breast quadrant. Due to hormonal fluctuation, many patients may experience tenderness a few days prior to menstruation. Tenderness as well as size may improve after menses. After observing the suspected fibroadenoma over 1 or 2 menstrual cycles, most adolescent patients can be reassured that the benign mass will regress spontaneously over time. Patients who are non-adolescents or have persistent lesions may require an ultrasound, which would reveal a solid, well-circumscribed, avascular mass. (Choice A) Axillary lymphadenopathy may accompany breast malignancy or infection. Malignancy in a young woman with a mobile breast mass is highly unlikely. Infection is also unlikely without fever, erythema, or significant pain. (Choice C) Eczema (atopic dermatitis) in children and adults typically causes scaly, erythematous, pruritic rashes on flexural surfaces (eg, antecubital fossa). Eczema involving the nipple and areola is rare and should be a red flag for Paget disease of the breast, which typically also produces pruritis and nipple flattening/retraction. (Choice D) Fibrocystic breast changes are common and typically present as palpable clusters of small masses or areas of thickening that are similar in both breasts. The associated breast pain is bilateral and generalized, with an increase in pain prior to menstrual onset. In contrast, fibroadenomas are typically solitary and unilateral, rather than multiple and bilateral. (Choice E) Resolution of a simple breast cyst is expected after needle aspiration. A simple breast cyst may present as a tender, solitary mass; however, the peak incidence is at age 35-50. It is much less common than fibroadenoma or fibrocystic breast changes in adolescents. Educational objective: An adolescent with a single, rubbery, mobile breast mass most likely has a fibroadenoma. Breast tenderness preceding menses typically improves after the menstrual period has ended. References: Pediatric and adolescent breast masses: A review of pathophysiology, imaging, diagnosis, and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/23345385) Diagnosis and management of fibroadenomas in the adolescent breast. (http://www.ncbi.nlm.nih.gov/pubmed/24872735) Breast diseases in adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/22846531)

A 16-Year-Old Girl Comes to the Office with a Breast