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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 102-104

Fibroadenoma of ectopic breast of axilla: A rare case report


Department of Surgery, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India

Date of Web Publication9-Jan-2015

Correspondence Address:
Umesh Jethwani
Department of Surgery, Ward No. 26, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.149064

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  Abstract 

Ectopic breast tissue (EBT) is a rare anomaly. Common location of EBT is along the milk line extending from the nipple to the symphysis pubis. EBT is susceptible to same pathologic processes as normal breast. Fibroadenoma though very frequent entity, but is very rarely reported in EBT of axilla. It poses a diagnostic challenge to the treating physician, and high index of suspicion is required for early detection. Here we report a rare case of fibroadenoma of EBT of axilla in a 25-year-old girl, which was managed by excision.

Keywords: Ectopic breast tissue, fibroadenoma, polymastia


How to cite this article:
Jethwani U, Saroha R, Bansal N, Verma R. Fibroadenoma of ectopic breast of axilla: A rare case report. Clin Cancer Investig J 2015;4:102-4

How to cite this URL:
Jethwani U, Saroha R, Bansal N, Verma R. Fibroadenoma of ectopic breast of axilla: A rare case report. Clin Cancer Investig J [serial online] 2015 [cited 2019 Oct 14];4:102-4. Available from: http://www.ccij-online.org/text.asp?2015/4/1/102/149064


  Introduction Top


Ectopic breast tissue (EBT)/polymastia refers to breast tissue at more than two places with or without nipple. EBT occurs in 1-6% of the general population and most commonly develop along the milk lines. [1] The most common localization of supernumerary breast is the line extending from the nipple to the symphysis pubis. These EBTs are also susceptible to pathologic diseases seen in normal breast. [2] We are reporting a rare case of fibroadenoma of EBT of axilla in 25-year-old girl. Excision was done under general anesthesia. Postoperative period was uneventful.


  Case report Top


A 25-year-old young girl presented with the complaints of a lump in the right axilla from 3 years that had gradually increased in size and associated with pain and discomfort. On examination, there was a lump of size 4 × 3 cm in the right axilla, which was soft to firm in consistency, nontender, freely mobile and separate from right breast [Figure 1]. Bilateral clinical breast examination was normal. Ultrasound examination showed a well-defined homogeneous lesion of size 4 × 3 cm, with internal echoes, in the axilla. Ultrasound examination of urogenital and cardiovascular system was normal. Fine-needle aspiration cytology (FNAC) of the lesion was suggestive of fibroadenoma. Patient underwent excision of right axillary fibroadenoma [Figure 2]. Histopathological examination confirmed the diagnosis of fibroadenoma in EBT [Figure 3]. Postoperative period was uneventful.
Figure 1: Preoperative photograph - Fibroadenoma of ectopic breast tissue of axilla

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Figure 2: Intraoperative picture of fibroadenoma in ectopic breast tissue

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Figure 3: Histopathology - Fibroadenoma

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  Discussion Top


Mammary ridges develop by thickening of ectoderm during the 5 th or 6 th week of embryogenesis. These run from axilla to groin. Two segments in the pectoral region develop into normal breasts, rest involutes. Ridges that fail to involute develop into EBT. [3]

Ectopic breast tissue appears on milk line, but rarely can occur on atypical sites such as face, vulva, perineum, posterior neck, thigh, shoulder, and axilla., [4]

Ectopic breast tissue have been classified by Kajava into eight types: [5]

  • Complete supernumerary nipple: Nipple, areola, and glandular breast tissue; known as the polymastia
  • Supernumerary nipple: Nipple and glandular tissue without areola
  • Supernumerary nipple: Areola and glandular tissue without nipple
  • Aberrant glandular tissue only
  • Supernumerary nipple: Nipple, areola, and pseudomamma, which is fat tissue that replaces the glandular tissue
  • Supernumerary nipple: Nipple only, which is known as polythelia, is the most common type
  • Supernumerary nipple: Areola only, which is known as polythelia areolaris
  • Patch of hair only, which is known as polythelia pilosa.


Clinical significance of EBT: [6],[7]

  • All pathologic changes that occur in normally positioned breast can develop in EBT
  • It may be associated with malignancies and other congenital abnormalities such as pyloric stenosis and urinary tract abnormalities (renal malformation, carcinoma)
  • Pathology in EBT poses a diagnostic challenge and should be differentiated from lipoma, follicular cyst, hamartoma, enlarged lymph node and torn muscle belly.


Fibroadenoma is a common benign disease of the breast in young age group. However, its occurrence in EBT is very rare and very few cases have been reported. [8]

Amaranathan et al. [9] have reported fibroadenoma of 4 × 4 cm in EBT in the axilla in a 31-year-old Asian female. Ultrasonogram of the local parts showed 2.8-1.6 cm space occupying lesion in the right axilla with well-defined and smooth margins and homogenous, hypoechoic internal echoes were noted. FNAC was suggestive of fibroadenoma. Patient underwent excision biopsy that was also suggestive of fibroadenoma in EBT.

Goyal et al. [10] reported fibroadenoma of EBT in the axilla, in a 23-year-old female, presenting as axillary masses. Mammograms of both pectoral breasts were normal. Ultrasonography of both urogenital and cardiovascular system was normal. Both axillary breasts were excised under general anesthesia and histopathological report revealed a well-defined, capsulated intracanalicular fibroadenoma in left accessory breast tissue

Borsook et al. [11] reported fibroadenoma of EBT of axilla in a 10-year-old female. Ultrasound revealed a solid mass with nonspecific features. Excisional biopsy showed a fibroadenoma arising in EBT.

Diagnosis of EBT is strongly suggested by history of cyclic changes during the menstrual period or by initial appearance during pregnancy. Pathology in EBT should be evaluated by the same methods as in normal breast tissue. Radiological examination should be done to rule out the urogenital malformation as supernumerary kidneys, renal agenesis, and carcinomas.

Ectopic breast tissue harbors the risk of malignant transformation and in the absence of nipple can delay the diagnosis. Such cases are associated with early and frequent metastasis.


  Conclusion Top


All axillary lumps should be seen with high index of suspicion. EBT in axilla poses a diagnostic challenge to the treating physician. Fibroadenoma is a common benign disease of young females, but its occurrence in EBT is very rare. It should be kept in the differential diagnosis of axillary swelling. Excision is treatment of choice for symptomatic EBT. Early detection of malignancy affects the prognosis of the patient.

 
  References Top

1.
Gutermuth J, Audring H, Voit C, Haas N. Primary carcinoma of ectopic axillary breast tissue. J Eur Acad Dermatol Venereol 2006;20:217-21.  Back to cited text no. 1
    
2.
Dixon JM, Mansel RE. ABC of breast diseases. Congenital problems and aberrations of normal breast development and involution. BMJ 1994;309:797-800.  Back to cited text no. 2
    
3.
Giron GL, Friedman I, Feldman S. Lobular carcinoma in ectopic axillary breast tissue. Am Surg 2004;70:312-5.  Back to cited text no. 3
    
4.
Tresserra F, Grases PJ, Izquierdo M, Cararach M, Fernandez-Cid A. Fibroadenoma phyllodes arising in vulvar supernumerary breast tissue: Report of two cases. Int J Gynecol Pathol 1998;17:171-3.  Back to cited text no. 4
    
5.
Kajava Y. The proportions of supernumerary nipples in the Finnish population. Duodecim 1915;31:143-70.  Back to cited text no. 5
    
6.
Pellegrini JR, Wagner RF Jr. Polythelia and associated conditions. Am Fam Physician 1983;28:129-32.  Back to cited text no. 6
    
7.
Méhes K. Association of supernumerary nipples with other anomalies. J Pediatr 1979;95:274-5.  Back to cited text no. 7
    
8.
Bayar S, Cakmak A, Akyol C, Demirci S. Fibroadenoma developing in an ectopic breast. J Breast Health 2009;5:112-3.  Back to cited text no. 8
    
9.
Amaranathan A, Balaguruswamy K, Bhat RV, Bora MK. An ectopic breast tissue presenting with fibroadenoma in axilla. Case Rep Surg 2013;2013:947295.  Back to cited text no. 9
    
10.
Goyal S, Ritu B, Sangwan S, Singh P. Fibroadenoma of axillary ectopic breast tissue: A rare clinical entity. Clin Cancer Invest J 2014;3:242-4.  Back to cited text no. 10
    
11.
Borsook J, Thorner PS, Grant R, Langer JC. Juvenile fibroadenoma arising in ectopic breast tissue presenting as an axillary mass. J Pediatr Surg Case Rep 2013;1359-61.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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