A 10 years old girl presented with rapidly enlarging left 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 (Fig. 1) 20 cm x 20 cm well-circumscribed, firm, non-tender and mobile lump was palpable in left breast with right 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.
Routine hematological and biochemical examinations were within normal limits. We particularly wanted to see if ESR was raised as tuberculosis was one of the differential diagnosis. Chest X-ray was normal. Ultrasonography of breast showed heterogenous parenchymal pattern suggestive of left breast fibroadenoma. The patient was subjected to fine-needle aspiration cytology (FNAC) of the breast lump with pathology suggesting fibroadenoma.
Surgical excision of left breast lump with preservation of normal breast tissue, skin and nipple-areola complex was carried out. The specimen was sent for histopathological examination which showed well encapsulated tumor 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 (Fig. 2).
Surgical excision with breast conservation resulted in very good cosmesis and patient satisfaction. She is in regular follow-up after 6 months of surgery and doing well.