Recurrent intraductal papilloma mimicking secretory breast cancer in a 10-year-old girl—a case report

Abstract

Breast masses are not uncommon in otherwise healthy young children. Most of these lesions are benign or due to premature thelarche. Carcinoma of the breasts in children is rare, accounting for less than 1% of all childhood cancers and less than 0.1% of all breast cancers. However, high index of suspicion is still necessary especially when the breast mass increases in size over the time—and biopsy should be considered. Here we present a case of suspicious secretory breast cancer diagnosed by pre-operative core-needle biopsy. That 10-year-old girl presented initially with right nipple discharge, subsequent triple assessment and core-needle biopsy suggested the diagnosis of secretory breast cancer. In view of the rare occurrence of pediatric breast cancer, radical surgery was not performed after detailed discussion with patient’s parents. Excisional biopsy was arranged instead and the plan was to proceed with radical cancer surgery only when malignancy is confirmed by excision. Pathology of the excisional biopsy showed intraductal papillary lesion. This case has demonstrated the diagnostic difficulty and ambiguity of pediatric breast lesion. Wide excision (or mastectomy) in pre-pubertal girl is a major undertaking. Prudent pathological re-examination before contemplating radical breast cancer surgery is warranted for any pathological discordance with clinical or radiological features.