Breast Lesions
Sherif Emil in Clinical Pediatric Surgery: A Case-Based Interactive Approach, 2019
Breast lesions in children have diverse etiologies and presentations, but the pediatric surgeon should be familiar with some reasonably common index presentations in order to appropriately intervene, not only to treat the problem, but also to avoid potentially devastating complications. The earliest presentations are in the neonatal period and include neonatal hypertrophy and Staphylococcal breast abscess. Neonatal hypertrophy may involve one or both breasts and is due to a prolactin surge secondary to falling estrogen levels. The pediatric surgeon may also be consulted for a “breast lesion” in a toddler or prepubertal girl and should recognize that premature thelarche may present as early as 2 years of age. Polythelia, or accessory breast tissue, can exist in both boys and girls anywhere along the milk line from the axilla to the umbilicus. Breast masses will usually present to the pediatric surgeon between the onset of puberty and early adulthood. In boys, the predominant breast lesion referred to pediatric surgeons is gynecomastia, which is usually unilateral.
Pubertal abnormalitiesPrecocious and delayed
Eduardo Lara-Torre, Veronica Gomez-Lobo in Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
The biochemical initiation of puberty follows many years of quiescent hypothalamic-pituitary-ovarian function. Pubertal progression may be altered by genetic variations, congenital or acquired structural defects of the brain, congenital or acquired defects of the ovary or its life span, nutrition, stress, or chronic disease. Timing of puberty refers specifically to when pubertal events occur, and certain pubertal events mark this timing, namely, thelarche and menarche. Pubertal progression can be an early indicator of underlying health conditions in a child. Evaluating both the timing and the tempo of puberty permits the practitioner to identify both normal, familial variations in puberty as well as pubertal disorders of precocity or delay. Precocious puberty describes pubertal changes occurring more than 2.5 standard deviations earlier than the mean. Central precocity is characterized by growth acceleration, bone age advancement, thelarche, and adrenarche occurring at earlier than expected ages, with pubertal levels of luteinizing hormone and follicle-stimulating hormone.
No association between estrogen receptor gene polymorphisms and premature thelarche in girls
Published in Gynecological Endocrinology, 2017
Hae Sang Lee, Jong Seo Yoon, Cheol Hwan So, Kyung Hee Kim, Jin Soon Hwang
Objective: Premature thelarche (PT) is a benign, nonprogressive condition defined as isolated breast development. While the pathophysiology of PT remains unclear, increased sensitivity to estrogen may cause PT. The aim of this study was to investigate the association between polymorphisms in the estrogen receptor alpha (ERα) gene and PT in girls. Methods: In this case–control study, we examined 96 girls referred for early breast development (before the age of 8 years). The control group included healthy Korean females with normal pubertal progression. Anthropometric and hormonal parameters were measured and PvuII and XbaI ERα gene polymorphisms were evaluated by PCR. Out of the 96 girls, all coding exon and exon-intron boundaries of ERα were sequenced from the DNA of 46 girls. Results: There was no significant difference in the distribution of PvuII and XbaI polymorphisms between patients and controls. However, the carriers of XbaI polymorphisms had more advanced Tanner stage than did the non-carriers. Also, four ERα gene polymorphisms were previously identified, but these polymorphisms had no clinical significance. Conclusion: No association was found between the ERα gene polymorphisms and PT in girls. However, XbaI polymorphisms may contribute to early breast budding.
Increased serum estrogenic bioactivity in girls with premature thelarche: a marker of environmental pollutant exposure?
Published in Gynecological Endocrinology, 2013
Françoise Paris, Laura Gaspari, Nadège Servant, Pascal Philibert, Charles Sultan
The aim of the work was to investigate the pathophysiology of isolated premature thelarche (IPT) by determining the impact of pre/postnatal exposure to endocrine disrupting chemicals (EDCs) through evaluation of total serum estrogenic bioactivity (EBA). The pathophysiology remains elusive, although recent investigations suggested the role of EDCs in premature female breast development. We investigated 15 girls with IPT. Plasma estradiol, follicle-stimulating hormone, and luteinizing hormone were measured in basal state and after gonadotropin-releasing hormone testing; bone age and uterine length were also assessed for all patients. Total EBA of patient serum was analyzed with an ultrasensitive bioassay that we previously developed and compared with that of 18 age-matched control girls. Parents were interviewed about their environmental/occupational exposure to EDCs during the patient’s prenatal/postnatal life. Nine families reported parental occupational/environmental EDCs exposure during prenatal/postnatal patient life; the mean total EBA found in these 9 IPT girls was significantly elevated (12.31 ± 6.64 pg/mL) in comparison with that of the 6 patients without exposure (2.53 ± 0.73 pg/mL) and the 18 age-matched controls (3.53 ± 2.23 pg/mL; p
Adolescent ovarian thecoma presenting as progressive hyperandrogenism: case report and review of the literature
Published in Gynecological Endocrinology, 2020
Laura Gaspari, Françoise Paris, Patrice Taourel, Marie-Odile Soyer-Gobillard, Nicolas Kalfa, Charles Sultan
Hyperandrogenism is frequent and under investigated in adolescent girls. A 15-year-6-month-old French girl presented with oligomenorrhea and slowly progressing virilization 2 years post-menarche. Medical history revealed prenatal pesticide exposure through maternal professional activity and recurrent premature thelarche. Severe hirsutism, mild facial acne and clitoromegaly were noted. Serum androgens (testosterone: 94 ng/dL, 4-androstenedione: 8.23 ng/mL) were high and non-classic 21-hydroxylase deficiency was excluded. Pelvic ultrasonography showed a left ovarian mass, confirmed by computed tomography scan. Tumor markers were negative. Laparoscopic surgery was performed. The pathological diagnosis was benign luteinized thecoma. Postoperatively, the menstrual cycle and serum androgens became normal and hirsutism slowly improved. Hyperandrogenism 2 years after menarche should be systematically investigated, even if slowly progressive, since it may be a symptom of a rare virilizing ovarian tumor, like thecoma.
Related Knowledge Centers
- Breast
- Gynecomastia
- Precocious Puberty
- Tanner Scale
- Areola
- Nipple
- 17Beta-Estradiol Hemihydrate