Breast-nonmalignant

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Breast-nonmalignant

General

Thelarche

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 24 September 2012, last major updated March 2010

Definition / Pathophysiology

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● Rapid growth of breasts at onset of puberty, usually age 10-11 in females

● Signifies entry into Tanner stage II of development (Arch Dis Child 1976;51:170)

Pathophysiology

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● Growth is due to fat deposition, periductal connective tissue and elongation and thickening of ductal system; growth may be sporadic

● Influenced by estrogens, growth hormone and prolactin, but not progesterone

● Excision of initial subareolar disc will lead to amastia after puberty

Epidemiology

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●

Clinical features

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● Premature if prior to 9 years; may be isolated, or part of (central) precocious puberty if other signs of puberty are present; no lobules present (BMC Pediatr 2008;8:27)

● Thelarche before age 8 years associated with increased BMI and non-Hispanic black and Mexican American ethnicity (Pediatrics 2009;123:84)

Tanner staging: Stage I; Stage II; Stage III; Stage IV; Stage V

Prognostic factors

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● No tests currently predict risk of precocious puberty (J Pediatr 2010;156:466)

Case reports

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● 18 month old girl with premature thelarche but no hormonal abnormalities (J Pediatr Endocrinol Metab 2009;22:751)

Clinical images

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Premature thelarche

Gross description (Macroscopy)

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● Rubbery subareolar discoid mass; may be asymmetric

Micro description (Histopathology)

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● Prior to puberty, breasts of both sexes have ducts with variable branching lined by cuboidal epithelium, no lobules, no necrosis

● At puberty in females, lobules develop

● Breast tissue in premature thelarche resembles gynecomastia with epithelial hyperplasia in ductal system in a solid or micropapillary configuration

Micro images

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Premature thelarche (9 year old girl with premature breast enlargement): AFIP - Proliferation of ducts without lobules; intraductal epithelial hyperplasia with uniform cells and prominent nuclei

Differential Diagnosis

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● (link to topic)

Additional references

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● Wikipedia

End of Breast-nonmalignant > General > Thelarche

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