Juvenile Fibroadenoma Detected at 2 Years and Rapid Growth at Thelarche: Case Report and Literature Review.

Abstract

Juvenile fibroadenoma typically is seen in the adolescent patient and has distinctive clinical and histopathological features that are related to the early onset of the benign tumor. Only rarely can juvenile fibroadenoma occur as a prepubertal lesion or may be detected earlier in childhood, raising questions about differential diagnosis and management of the lesion. We present a case of very early first manifestation of juvenile fibroadenoma in a 2-year-old patient. Under clinical observation and conservative management over a 7-year period, there was no progression. At the age of 9 years, rapid growth of the lesion occurred causing clinical symptoms. Complete surgical excision resulted in a good clinical outcome. Histologically, the diagnosis of juvenile fibroadenoma was made. In summary, juvenile fibroadenoma is the most common breast neoplasia in adolescents and may cause excessive unilateral growth resulting in gross asymmetry and pain. However, it can be detectable in early childhood and after a dormant period of several years, as in this case, lead to sudden massive growth at the onset of puberty. The clinical management should include an interdisciplinary treatment approach with gynecology, pediatrics, and pediatric surgery to balance the risks and benefits of conservative management. Surgical removal can be safely postponed until it becomes necessary due to clinical symptoms.