Juvenile giant fibroadenoma is a very rare breast disease affecting young girls of premenarche and adolescent age groups. or bilateral breasts. Juvenile giant fibroadenoma causes such a medical demonstration. Ultrasonography and MRI help to characterise these breast masses better. Imaging guidance is also useful for an accurate good needle aspiration or core needle biopsy to differentiate this mass as benign or malignant. This facilitates better surgical management. We could not find the MRI and digital subtraction angiographic (DSA) features of this entity in the literature until now. Endovascular embolisation of these huge masses is useful preoperatively to reduce the tumour vascularity which aids in easier surgical excision. Case demonstration A girl aged 13 years presented with massively enlarged bilateral breasts with severe discomfort for 8?weeks. Both breasts grew rapidly to the present size starting soon after menarche. She experienced no history of trauma, fever, discharge, loss of excess weight or loss of appetite and no family history of breast malignancy. On medical exam, gigantic enlargement of bilateral breasts was seen extending downward until bilateral iliac regions with multiple dilated superficial veins (number 1A). Pores and skin over both breasts showed areas of redness and hyperpigmentation. Bilateral nippleCareola complexes were stretched out by the masses. There was no regional lymphadenopathy. Open in a Rabbit Polyclonal to GRAK separate window Figure?1 (A) Clinical photograph showing gigantic enlargement of bilateral breasts reaching up to bilateral iliac regions, (B) sonography with high-rate of recurrence transducer showing circumscribed hypoechoic mass component ((E) MR angiography showing bilateral lateral thoracic arteries ( em white arrowheads /em ) and dilated bilateral internal mammary arteries ( em black arrowheads /em ) and their branches. Good needle aspiration cytology Smear showed diffusely cellular stroma, bedding of epithelial cells and multiple bare nuclei with no atypia. These features were representative of benign fibroepithelial tumour. Differential analysis The medical differential diagnoses clinically are juvenile (virginal) breast hypertrophy and phyllodes tumour. Juvenile hypertrophy causes massive diffuse enlargement of both breasts with no unique mass within. This was ruled out by sonography and MRI. Phyllodes tumour usually affects unilateral breast and is much more common in adults (quite unusual in prepubertal age or adolescence).2 However, excision biopsy was performed to rule out malignant phyllodes tumour. Rapidly growing breast mass could hardly ever become metastasis GS-1101 kinase activity assay from rhabdomyosarcoma, leukaemia, lymphoma, primitive neuroectodermal tumours, Ewing sarcoma, malignant melanoma and renal cell carcinoma.3 However, the size of such masses is not usually as gigantic as in our individual. Treatment The individual underwent endovascular embolisation for bilateral breasts masses, ahead GS-1101 kinase activity assay of surgery, to lessen the vascularity of the large-sized masses. DSA of bilateral subclavian arteries demonstrated the inner mammary arteries with their branches and the lateral thoracic arteries providing bilateral breasts masses (figure 3A, B of the still left breast; amount 4A,B of the proper breast). The inner mammary arterial branches and lateral thoracic arterial branches of every side had been superselectively catheterised and embolised using graded gel foam contaminants. Postembolisation angiogram demonstrated no stream in these arteries (amount 3C, D of the left breasts; amount 4C, D of the proper breasts). Open in another window Figure?3 Digital subtraction angiography of the still left side. (A) Dilated still left lateral thoracic artery and its own branches ( em white arrowhead /em ), (B) dilated branch of the still left inner mammary artery ( em dark arrowhead /em ), (C) postembolisation of the still left lateral thoracic artery and its own branches ( em white arrowhead /em )no stream within them and GS-1101 kinase activity assay (D) postembolisation of the left inner mammary arterial branches ( em dark arrowhead /em )no stream within the branches. Open in another window Figure?4 Digital subtraction angiography of the proper side. (A) Best lateral thoracic artery and its own branches ( em white arrowhead /em ), (B) right inner GS-1101 kinase activity assay mammary artery and its own branches ( em dark arrowhead /em ), (C) postembolisation of the proper lateral thoracic artery and.