Giant Juvenile Fibroadenoma During Covid-19 Pandemic; Challenges and Solutions

Breast lump in adolescents is rare, accounting for around 3.2% and mostly are benign. However, its presence causes anxiety to the young patients and their parents. Giant juvenile fibroadenoma is even more uncommon, approximating to only 0.5% of all breast lump cases. Major challenges in managing juvenile breast lump include getting to the accurate diagnosis, selecting the best surgical approach, attaining the best cosmetic outcome, and preserving normal breast tissue for future breast feeding. Deciding the optimal time for surgery is another concern during Covid-19 pandemic as the intention to treat needs to balance with the risk of contracting the pandemic. Here we present a case of a 15-year-old girl who presented with a progressive growing unilateral right breast lump for the past 6 months, associated with mild discomfort and overlying skin changes. Examination revealed a huge lump occupying the entire right breast, measuring 10cm x 10cm. Ipsilateral axillary lymph node was non-palpable, and the contralateral breast was normal. Ultrasound of the breast showed heterogenous hypoechoic lesion with no malignancy features. Tissue biopsy of the lesion revealed a benign fibro-epithelial lesion. She subsequently underwent right breast excision biopsy, and the histopathology revealed a giant juvenile fibroadenoma.