A RARE CASE OF BILATERAL MULTIPLE GIANT JUVENILE FIBROADENOMAS IN ADOLESCENT WITH REPLACEMENT OF NORMAL BREAST TISSUE

Objectives: Giant juvenile fibroadenomas are usually seen as rare variants of fibroadenomas in adolescents as unilateral solitary masses that may be managed by surgical excision with conservation of normal breast tissue. We report a case of a premenarchal 13-year-old female presenting with bilateral multifocal giant juvenile fibroadenomas who essentially required bilateral subtotal nipple sparing mastectomies. Rapid growth of her right sided fibroadenomas led to skin ulceration prompting urgent excision. At the time of surgical excision the masses had almost entirely replaced normal breast tissue and the tumor was transected to leave a small amount of subareolar tissue behind. Due to the difficulty of the initial excision on the right side, the masses on the left side were not excised during the initial case. Her post-operative course was also complicated by a post-operative hematoma requiring evacuation of hematoma. Ultrasound performed post operatively showed development of new right sided fibroadenomas as well as increased subareolar fibroadenoma and increasing size of the fibroadenoma on the left side. The patient then underwent removal of remaining abnormal tissue on the right and all masses on the left leaving behind the minimal normal tissue that was encountered. The masses on the right totaled 59 cm in size and on the left 24 cm in size. Fibroadenomas typically displace normal breast tissue therefore after excision the displaced breast tissue will fill the space. In this case the excessive size and multifocal nature of the fibroadenomas developing prior to menarche did not leave behind much normal breast parenchyma. Normal tissue was only seen in minimal amounts at the very edges of the breast. An initial attempt was performed at the first operation to preserve some tissue immediately deep to the nipple areolar complex despite the lack of normal tissue, but the transection of this abnormal tissue was thought to be the cause of the post-operative hematoma given the venous congestion within large fibroadenomas. One month after the initial operation the patient already developed two new fibroadenomas not palpable at initial excision. This develops concern for future lesions. Giant juvenile fibroadenomas are benign tumors that can present as complicated cases when large and multifocal replacing the majority of normal breast parenchyma. They may recur despite complete removal of majority of the breast parenchyma. Further data for recurrence of giant juvenile fibroadenomas after mastectomy is not available. Complete excision to prevent further recurrence is indicated, and patients can have satisfactory outcomes.

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