Pediatric emergency medicine trisk 0424 0424

epithelial cell proliferation. If the discharge persists after delivery, a more
thorough investigation for alternate etiologies is recommended. Fibroadenomas
often increase in size during pregnancy and may result in significant pain.
Excision is often advised for any solitary mass and the patient should be
expediently referred to a breast surgeon. The number of cases of breast
malignancy diagnosed during pregnancy is very low.

Miscellaneous Breast Lesions
Congenital Lesions
Supernumerary breasts (polymastia) and supernumerary nipples (polythelia) are
congenital conditions that are unlikely to present as chief complaints in the ED,
but that may be discovered incidentally on examination. Polymastia results from
failure of the embryonic mammary ridges to regress and is present at birth, often
resembling skin tags or nevi, and may not be noticed until the tissue is
hormonally influenced. Supernumerary breasts are most commonly found in the
axillae but have been reported to occur in several locations. This ectopic tissue
may become tender with menses and has been reported to develop the same range
of pathology as normal breast tissue, necessitating excision under certain
circumstances.
Polythelia may be sporadic or familial, and is most commonly found on the
left, inferior to the normal nipple. In newborns, polythelia may appear as small,
wrinkled lesions with or without pigmentation. Polythelia is typically of little
significance, though there is a possible association with unsuspected urologic
anomalies. For this reason, patients with polythelia should be referred for at least
a primary screening of underlying urologic disease. Otherwise, this disorder
requires no treatment unless the diagnosis is uncertain (e.g., the lesion looks like a
possible melanoma) or is perceived as a cosmetic problem.
Premature Thelarche
Premature thelarche refers to isolated breast development without other signs of
puberty. Minimum acceptable age for thelarche is 8 years; appearance of breast
tissue prior to this age should prompt consultation with an endocrinologist.

Typically appearing within the first 2 years of life in its most common form,
premature thelarche is a benign, transient condition of unknown etiology. Cases
of premature thelarche usually present to the ED secondary to concern raised by
parents of prepubertal girls, and reassurance is usually all that is required.
However, premature thelarche may be the first sign of true precocious puberty or