Giant fibroepithelial breast tumour in an adolescent: a diagnostic and surgical challenge—case report
Oskar Guzman, Jenny HeimanAbstract
Introduction
Breast lesions in adolescents are common and most often benign, with fibroadenomas being the most common tumour type. Giant fibroadenomas and phyllodes tumours are rare fibroepithelial lesions that may present with rapid growth and large tumour size. Differentiating between these entities preoperatively is difficult, as clinical examination, imaging and core needle biopsy may not reliably distinguish between them. The distinction is important because surgical management differs.
Methods
We present the case of a 15-year old girl with a large tumour in the right breast.
Results
Imaging demonstrated a large lesion measuring more than 16 cm. Core needle biopsy suggested a fibroepithelial lesion, and a phyllodes tumour could not be excluded. The case was discussed at a multidisciplinary conference, and surgical excision was recommended. The tumour was excised completely through a laterally extended semi-periareolar incision and weighed 960 g. No skin was excised, nor tissue mobilization performed. Final histopathology is pending and will be supplemented.
Discussion
Large fibroepithelial tumours in adolescents are rare and present a diagnostic and surgical challenge. In this case, the literature suggested that normal breast tissue can grow, altough no cut-offs regarding excised volume exists. Since no malignancy was concluded preoperatively, a diagnostic wide local excision was chosen. The incision was placed to be excisable, should a later mastectomy or mastopexy be needed. When phyllodes tumours cannot be excluded preoperatively, the surgeon must balance oncological safety with preservation of breast tissue and cosmetic outcome. Surgical excision is often required for definitive diagnosis and treatment, making careful surgical planning necessary.