Pubertal Macromastia

Definition

• Massive diffuse breast enlargement in a young woman

Alternate/Historical Names

• Juvenile hypertrophy
• Physiologic hypertrophy
• Virginal hypertrophy
• Juvenile gigantomastia

Diagnostic Criteria

• Diffuse, massive enlargement
  • No discrete masses
  • May be asymmetric or unilateral
  • May weigh several kilograms
• Usually occurs in adolescence
  • Most cases in range 10-17 years
  • Recurrences may occur later
• Histologic features similar to gynecomastia
  • Predominantly fibrous tissue
    • May be hyalinized or loose fibrous tissue with fat
  • Ducts present, may show epithelial hyperplasia
  • Lobules absent or poorly formed

Richard L Kempson MD
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting: May 27, 2006

Supplemental studies

Immunohistology

• No reported studies

Differential Diagnosis

• Juvenile fibroadenoma
• Phyllodes tumor
• Juvenile papillomatosis

Pubertal Macromastia	Juvenile Fibroadenoma
Diffuse, not circumscribed	Circumscribed
Fibrous or fatty stroma	Cellular stroma
Rare	More common as a cause of adolescent breast enlargement

Both may cause rapid, massive growth

Pubertal Macromastia	Phyllodes Tumor
Young age (10-17 years)	Almost all over 30 years
No discrete mass	Mass usually present
No broad papillae	Broad papillae inserted into spaces
Paucicellular stroma	Cellular stroma
No stromal mitotic figures	May have stromal mitotic activity
No stromal atypia	Stromal atypia may be present

Both may cause rapid, massive growth

Pubertal Macromastia	Juvenile Papillomatosis
Diffuse	Circumscribed
Massive enlargement	Mean size 4 cm
Usually bilateral	Usually solitary
Predominantly stromal process	Prominent cysts

Clinical

• Diffuse, massive enlargement
  • No discrete masses
  • Usually bilateral
    • May be asymmetric or unilateral
• Usually occurs in adolescence
  • Most cases in range 10-17 years
  • Recurrences may occur later
• Frequent, rapid recurrence may occur following subtotal resection
• Recurrence reported with pregnancy
• Regression not reported
• Drug therapy may stop or slow progression
• Familial cases have been reported

Lists

Breast lesions preferentially presenting in juvenile/adolescent/pubertal breast

(These may, of course occasionally present at other ages and other lesions may rarely present at this age)

• Gynecomastia
• Juvenile Fibroadenoma
• Juvenile Papillomatosis
• Pubertal Macromastia
• Secretory Carcinoma

Bibliography

• Baker SB, Burkey BA, Thornton P, LaRossa D. Juvenile gigantomastia: presentation of four cases and review of the literature. Ann Plast Surg. 2001 May;46(5):517-25; discussion 525-6.
• Kupfer D, Dingman D, Broadbent R. Juvenile breast hypertrophy: report of a familial pattern and review of the literature. Plast Reconstr Surg. 1992 Aug;90(2):303-9.
• Govrin-Yehudain J, Kogan L, Cohen HI, Falik-Zaccai TC. Familial juvenile hypertrophy of the breast. J Adolesc Health. 2004 Aug;35(2):151-5.