GIANT JUVENILE FIBROADENOMA OF

BREAST MIMICKING PHYLLOIDES

TUMOUR – A CASE REPORT
Presentor: DR.B.SRIDHAR
Post Graduate
Department Of General Surgery
Government Stanley Medical College & Hospital

Guide: Prof DR.T.SIVAKUMAR MS

Dr.G.CHANDRASEKAR MS
Dr.JIM JEBAKUMAR MS
 INTRODUCTION
• Fibroadenoma is considered “giant” when they attain
the size more than 5 cm and/or weigh more than 500
grams. Giant fibroadenoma is a rare variant which
comprising 4% of all fibroadenomas of which
juvenile fibroadenoma constitutes only 0.5%.

• Giant fibroadenomas are extremely rare in pre-

pubertal girls. Through this case report we want to
highlight the clinical approach and management of
giant fibroadenoma in pre-pubertal girls.
 CASE REPORT
• A 12 years old girl presented with rapidly enlarging right breast for
1 year duration without any history of pain, trauma, fever, anorexia
and weight loss. She has not attained her menarche and there was
no significant family history.
On clinical examination 20 cm × 15
cm well-circumscribed, firm, non-
tender and mobile lump was palpable
in right breast with left breast being
normal. The lump was not fixed to
skin or underlying muscle. The
overlying skin was tense and shiny
with prominent superficial veins.
There was no discharge from the
nipple, and axillary lymph-
adenopathy was absent.
 CASE REPORT
Routine hematological and biochemical examinations were
within normal limits. Chest X-ray was normal
• Ultrasonography shows large
multiple heteroechoic lesion
replacing entire breast.
Histopathology examination
through a Fine needle
aspiration biopsy shows
impression of fibroadeoma;
however, we were unable to
exclude a diagnosis of
phyllodes tumor and hence
surgical excision was required
for full analysis.
• Surgical excision of left breast lump with
preservation of normal breast tissue, skin
and nipple-areola complex was carried
out. The resected specimen weighed 900
grams with size of 18x12x8 cms .Cut
section showed lobulations with slit like
spaces, some areas shows cut cabbage
appearance.
• Section study shows encapsulated
neoplasm with hyperplasia of both
epithelial and stromal components. The
glands were lined by bilayered epithelium
with pericanalicular pattern of
fibroadenoma and absence of cytological
atypia. The final histopathological
diagnosis of Giant Juvenile Fibroadenoma
of breast was given
 CASE REPORT

Surgical excision with

breast conservation
resulted in very good
cosmesis and patient
satisfaction. A
submammary incision is
preferred to provide good
cosmesis. She is in
regular follow-up after 6
months of surgery and
doing well.
 DISCUSSION
• Fibroadenoma is extremely rare in very young children, with the
earliest known published case in a 13-month-old girl. Excessive
estrogen stimulation and / or receptor sensitivity or reduced
levels of estrogen antagonist during puberty have been
implicated in pathogenesis.
• Important differential diagnosis to be considered are Virginal
hypertrophy, phylloides tumour, premature thelarche,lipoma,
hamartoma, breast abscess, macrocyst, adenocarcinoma, Pseudo
angiomatous stromal hyperplasia,fibrosarcoma and
lymphangioma.
• Histologically, juvenile fibroadenomas appear more cellular
with fewer lobular components than simple fibroadenomas. In
contrast to phyllodes tumours, juvenile fibroadenoma often
shows hyperplasia of ductal epithelium with lack of leaf-like
structure and stromal cell atypia.
 CONCLUSION
Juvenile breast lesions are rare. Multiple factors must
be taken into consideration in terms of clinical,
physiological, and psychological care and maturation of
the adolescent. Counselling of the patient and the
parents are key to the management of this pathology
along with avoidance of missing any rare malignant
pathology.

A surgical approach requires thorough and detailed

planning to ensure a fine balance between adequate
resection and the best cosmetic outcome for a
developing breast.