Large breast masses in young patients: a multi-disciplinary approach to an uncommon clinical scenario.

To the Editor: Large palpable breast masses in young patients can be attributed incorrectly to asymmetric breast development. Significant breast pathology is often overlooked, given the low numbers of breast masses seen in adolescents and young adults. Today, ultrasound is the primary modality used for evaluating young patients with palpable lumps. If any sonographic findings are suspicious, the patient may require mammography for complete characterization. In many cases, breast magnetic resonance imaging (MRI) can be useful for surgical planning. Case 1. A 15-year-old girl presented with asymmetry of her breasts beginning 18 months earlier. Clinical examination showed unilateral hypertrophy of the right breast with venous stasis changes in the tense overlying skin (Fig. 1). Needle biopsy samples were obtained through the mass. Initial pathology showed a cellular tumor either a cellular juvenile fibroadenoma or low-grade phyllodes. Excisional biopsy confirmed a cellular juvenile fibroadenoma. Imaging included ultrasound and breast MRI, which demonstrated a 12-cm mass (Fig. 2). Consensus for complete excision was made due to patient’s desire for breast symmetry. At the time of surgical removal, the entire mass was encapsulated and easily mobilized. Surgical consultation with a plastic surgeon was offered for cosmetic reasons following the excision. Case 2. A lactating 21-year-old female presented with a 10-cm left breast mass, erythematous skin, and prominent skin veins. Subsequent ultrasound guided core biopsy for surgical planning showed a benign phyllodes tumor. Breast MRI showed a circumscribed 10 · 9.4 · 8.5 cm mass (Fig. 3). During surgical excision, the tumor was easily dissected from the surrounding tissue and contained milk products. The patient was able to continue breast feeding from the left breast following surgery.