Purpose or Case Report: With an incidence of 3.25%, breast masses in the pediatric population are a relatively rare phenomenon. Despite this, breast masses are a substantial source of anxiety and concern for parents and patients alike, largely due to the increased awareness of breast cancer in the adult population. Fortunately, the vast majority of masses are benign, and pediatric breast malignancies constitute less than 1% of all pediatric malignancies. Moreover, malignancy tends to be secondary to metastatic disease from lymphoma, leukemia, or rhabdomyosarcoma, as primary breast carcinoma is exceedingly rare. Although initial sonographic characteristics of breast masses may be nonspecific, recommendation for further evaluation with biopsy and/or excision of the mass is usually not recommended due to the rarity of malignancy, and avoidance of disrupting immature breast parenchymal tissue. In adults, the Breast Imaging-Reporting and Data System classification is quite accurate for dictating management recommendations. However, this system grossly over-emphasizes the risk of malignancy in pediatric patients, as imaging findings are usually discordant with histology. Currently, there are no standardized guidelines for management recommendations of pediatric breast masses, and short-term follow-up ultrasound is usually recommended to evaluate for malignant potential. The purpose of this educational exhibit is to compare the sonographic abnormalities of breast pathologies arising from normal breast development, including but not limited to gynecomastia, mastitis, and abscesses, from those arising from neoplastic processes including fibroadenomas, hemangiomas, arterio-venous malformations, and phyllodes tumors. In addition, the current literature on management recommendations, including indications for MRI and biopsy/excision of breast masses, will be reviewed. Finally, this exhibit will discuss the important role pediatric radiologists play in understanding the epidemiology and natural history of breast pathologies, enabling accurate characterization of masses and appropriate treatment recommendations to further guide patient management.
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