Giant juvenile fibroadenoma in an adolescent female: A case
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Giant juvenile fibroadenoma in adolescents should be dealt with utmost caution as this may be associated with anxiety, fear, and emotional factors. The treatment should aim for preserving the normal contour of the breast along with appealing scar. It is one of the rarer clinical findings in adolescent females which needs to be differentiated from phyllodes tumor, physiological hypertrophy, and other inflammatory lesions like breast abscess. Treatment includes removal of tumor with maintenance of normal breast contour.

An 18-year-old unmarried lady presented to surgical outpatient department with complaints of lump in the right breast for 6 months. The lump was gradual in onset, freely mobile, initially a size of a marble, gradually which increased to the present size throughout the duration of time. The mass was not associated with pain or skin color changes or any abnormal discharge per nipple. Her menarche was at 13 years with regular menstrual cycle. Vitals were stable.

Right breast examination revealed a freely mobile mass involving central area of the breast along with right upper and lower quadrant approximately the size of 10 cm × 9 cm with no adherence to the skin or fixity to the posterior wall; however, overlying skin was slightly tensed with distended superficial veins. It was nontender, well circumscribed, and firm in consistency. Nipple appeared slightly fissured. Axillary lymph nodes were not palpable. Left breast examination was normal.

Ultrasonography of right breast showed inhomogeneous solid mass measuring 85.9 × 74.6 mm with posterior acoustic enhancement in right breast suggestive of fibroadenoma. Pathological examination with FNAC was not possible due to reluctance of the patient. Mammography bilateral breast showed dense fibro-glandular parenchyma along with well-defined, large oval-shaped equal to low-density lesion with lobulated margin in the peri-areolar region of the right breast .

The patient was taken for surgery, and enucleation of the tumor was done with inframammary incision along the right breast. Intraoperatively, the tumor was 9 cm × 7 cm in size, firm, ovoid, well circumscribed with bosselated surface with nodularity. Cut section of the mass showed many slit-like spaces with gray white in color. Postoperative event remained uneventful. The patient got discharged on 4th postoperative day. Histopathology was consistent with complex juvenile fibroadenoma.