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Case Report Fibroadenoma in Ectopic Breast Tissue Mohammed EH Azoz Mass for One Year

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Case Report Fibroadenoma in Ectopic Breast Tissue Mohammed EH Azoz Mass for One Year Case Report Fibroadenoma in ectopic breast tissue: a case report Mohammed EH Azoz ,MD*,Abdalla E Abdalla, MSc**, Mutaz M Elhassan, MD*** Department of Surgery*, Department of Anatomy**, Department of Pathology*** Kosti Teaching Hospital, Faculty of Medicine, University of El Imam El Mahdi-Kosti, Sudan. ورم ﻏﺪي ﻟﻴﻔﻲ ﻓﻲ ﻧﺴﻴﺞ ﺛﺪﻳﻲ إﺿﺎﻓﻲ ، دراﺳﺔ ﺣﺎﻟﺔ ﻣﺤﻤﺪ اﻟﺘﻮم ﺣﺎﻣﺪ ﻋﺰوز: اﺳﺘﺸﺎري اﻟﺠﺮاﺣﺔ اﻟﻌﺎﻣﺔ. ﻋﺒﺪاﷲ اﻷﻣﻴﻦ ﻋﺒﺪاﷲ : ﻣﺤﺎﺿﺮ ﻋﻠﻢ اﻟﺘﺸﺮﻳﺢ. ﻣﻌﺘﺰ ﻣﺤﻤﺪ اﻟﺤﺴﻦ : اﺧﺘﺼﺎﺻﻲ ﻋﻠﻢ اﻷﻣﺮاض. اﻟﻤﻠﺨﺺ: آﺜﺮة اﻷﺛﺪاء ، وﻳﺴﻤﻰ أﻳﻀﺎً زﻳﺎدة ﻋﺪد اﻷﺛﺪاء أو اﻟﻨﺴﻴﺞ اﻟﺜﺪﻳﻲ اﻹﺿﺎﻓﻲ، وﻳﻌﺮف ﺑﺄﻧﻪ وﺟﻮد أآﺜﺮ ﻣﻦ ﺛﺪﻳﻴﻦ ﻣﻊ أو ﺑﺪون اﻟﺤﻠﻤﺔ واﻟﻬﺎﻟﺔ ﻓﻲ اﻟﺒﺸﺮ. هﺬا اﻟﺘﻘﺮﻳﺮ ﻋﻦ ﺣﺎﻟﺔ ﻓﺘﺎة ﻋﻤﺮهﺎ 24 ﺳﻨﺔ، ﺣﻀﺮت وهﻲ ﺗﺸﻜﻮ ﻣﻦ ورم ﺗﺤﺖ ﺟﻠﺪ اﻹﺑﻂ اﻷﻳﻤﻦ و ورم ﻓﻲ اﻟﺜﺪي اﻷﻳﺴﺮ ﻟﻤﺪة ﺳﻨﺔ. أُﺧﺬت ﺧﺰﻋﺔ وأﻇﻬﺮت ﻣﻼﻣﺢ ورم ﻏﺪي ﻟﻴﻔﻲ ﺗﺤﺖ ﺟﻠﺪ اﻹﺑﻂ اﻷﻳﻤﻦ واﻟﺜﺪي اﻷﻳﺴﺮ. ﺧﻀﻌﺖ اﻟﻤﺮﻳﻀﺔ ﻟﺠﺮاﺣﺔ اﺳﺘﺌﺼﺎﻟﻴﺔ ﻟﻠﻮرﻣﻴﻦ. وأﻇﻬﺮ اﻟﻔﺤﺺ اﻟﻨﺴﻴﺠﻲ ﻟﻠﻌﻴﻨﺘﻴﻦ اﻟﻤﺴﺘﺄﺻﻠﺘﻴﻦ ورم ﻏﺪي ﻟﻴﻔﻲ ﻓﻲ آﻠﺘﻴﻬﻤﺎ. Abstract along the primitive embryonic milk lines, Polymastia, also known as supernumerary or which extends from the axilla to the groin, and accessory breast, is defined as the presence of may occur unilaterally or bilaterally(1). more than two breasts with or without a nipple Axillary breast tissue is a common variant of and areola in human beings. We report a case EBT, with a reported incidence of 2 to 6% in of a 24-year-old female presented with right women(2). It is twice as common in females as axillary subcutaneous swelling and left breast in males(3). It can be seen during or before swelling for one year. Fine needle aspiration puberty and is often noted during cytology showed features of fibroadenoma in pregnancy(3). Normally ectopic breast tissue the ectopic breast tissue for the axillary appears sporadically. However, it is suspected swelling and fibroadenoma for the left breast that it may also be a hereditary condition(2). swelling. Patient underwent excisional biopsy Ectopic breast tissue is subject to hormonal for both masses. Histological examination of response and may develop benign and resected specimens confirmed the diagnosis of malignant pathologic processes similar to fibroadenoma in both breast tissues. those seen in normally located breast tissues, Keywords: Ectopic breast tissue, including fibrocystic disease, fibroadenoma, fibroadenoma. intraductal papilloma, lactating adenoma and Introduction carcinoma(2,3,4). Ectopic breast tissue (EBT) occurs anywhere We report a case of a 24-year-old woman, ________________________________ who presented with left breast mobile mass Corresponding author and right axillary subcutaneous mass, Mohammed Eltoum Hamed Azoz histologically proved to be fibroadenomas. Consultant Surgeon and Head Department of We reviewed the incidence, development, Surgery, Kosti Teaching Hospital, classification, clinical presentation and Director of Abdalla Mohammed Salih surgical options for treatment. Specialized Centre, Kosti Sudan. Case report Email: [email protected] A 24-year-old female presented to the Tel: 00249-912247390 outpatient clinic complaining of right axillary 112 Sudan Med J 2014 August;50(2) Case Report Fibroadenoma in ectopic breast tissue Mohammed EH Azoz mass for one year. It was gradually increasing Fig 2: The fibroadenoma in the right axilla. in size and associated with pain and discomfort. On examination there was a right axillary subcutaneous swelling, 4x3 cm in size (Fig 1). Fig 1: The fibroadenoma in the right axilla. The patient had an uneventful postoperative course. Discussion During the 6th week of embryonic development, the mammary milk line, which represents two ectodermal thickenings, develop along the sides of the embryo, extending from the axillary region to the groin(4). In normal development, most of the embryonic mammary ridges resolve, except for two segments in the pectoral region, which later become breasts(4). Failure of any portion It was firm in consistency, not tender, freely of the mammary ridge to involute can lead to mobile and completely separated from the ectopic breast tissue with (Polythelia) or right breast. The skin over this swelling was without (Polymastia) a nipple-areolar normal. The right breast and left axilla were (4) complex .Therefore, ectopic breast usually clinically normal. In the upper outer quadrant occurs along the ''milk line'' or mammary of the left breast there was a 2x1 cm mass, (4) line . which was firm in consistency, freely mobile Ectopic breast tissues are reported in locations and not tender. other than the milk line, face(5), foot(6), lumbar Fine needle aspiration cytology of the right region, vulva(7), perineum and the anus(8). axillary swelling showed cohesive clusters of Supernumerary tissues present in any location benign ductal cells, myoepithelial cells and other than along the milk line are supported stromal fibrous tissue fragments. No evidence by two beliefs. One is that it represents a of malignancy. These features were of migratory arrest of breast primordium during fibroadenoma in an ectopic breast tissue. chest wall development(9). The other belief is Similarly FNAC of the left breast swelling that it develops from the modified apocrine also showed features of fibroadenoma. sweat glands(10). Abdominal ultrasonography showed ectopic Kajafa(11) published a classification system for right pelvic kidney. supernumerary breast tissue as follows: The patient underwent excisional biopsy for Class I consists of a complete breast with both masses. Intraoperatively the right axillary nipple, areola and glandular tissue. swelling was found subcutaneously (Fig 2). Class II consists of a nipple and glandular Histological examination confirmed the tissue but no areola. presence of fibroadenoma in both resected specimens. 113 Sudan Med J 2014 August;50(2) Case Report Fibroadenoma in ectopic breast tissue Mohammed EH Azoz Class III consists of an areola and glandular positioned breasts and can be a marker for tissue but no nipple. urologic malformation or a urogenital Class IV consists of glandular tissue only. malignancies(12). In this case, there is ectopic Class V consists of a nipple and an areola but right kidney in the pelvis. no glandular tissue pseudomamma. Tumours in supernumerary breast tissue Class VI consists of a nipple only (Polythelia). should be diagnosed with the same methods Class VII consists of an areola only applied to normal breast tissue (Polythelia areolaris). (mammography, ultrasonography cytology Class VIII consists of a patch of hair only and biopsy), observing specific indications (Polythelia pilosa). (13). Fine needle aspiration cytology is very Our case belongs to class IV. valuable in diagnosing the lesion in ectopic As compared to pectoral breast tissue, ectopic breast tissue(14). breast tissue demonstrates the same hormonal The treatment options for ectopic breast tissue effects and is at risk of developing breast depend upon the psychological factors, diseases. During menses or pregnancy, symptoms and the presence of pathology(14). hormonal stimulation may cause enlargement Concerning surgical treatment, if it is and discomfort. Ectopic breast tissue can malignant a wider excision with lymph node undergo lactational changes during pregnancy, dissection must be considered(15). If it is and in the presence of a nipple-areolar benign, then simple excision is required for complex, it can give rise to lactational definitive diagnosis and to prevent the future secretion(4). This explains why this lady risk of cancer(15). In this case we did simple developed fibroadenomas in pectoral breast excision because it was benign. Superficial and in ectopic breast tissue concomitantly as location of this lesion explains why this is an both tissues exposed and reacted to hormonal example of ectopic breast tissue rather than an stimulation in the same manner. extension of breast parynchyma into the axilla In most cases, accessory breasts are ''axillary tail of Spence'' which is located deep. asymptomatic and cause nothing more than a Diagnosis of fibroadenoma in the axilla is visible distension which may resemble a rare. Fibroadenoma originating from an tumour. Sometimes it could cause ectopic breast should be taken into psychological disturbances in adolescence and consideration in the differential diagnosis of it may give pain and discomfort especially axillary masses. Ectopic breast tissue develops during menstruation, pregnancy and diseases as those of pectoral breasts and can lactation(4). be at the same time. In routine screening The clinical differential diagnosis for a programmes for breast cancer, a clinical solitary axillary mass is very broad. In examination should be made for the presence addition to ectopic breast tissue it includes for ectopic breast tissue, and if present it primary malignancy, benign cutaneous or should be subjected to routine screening as subcutaneous tumours, and infectious and well, along with the normally positioned vascular lesions, as well as an axillary tail of breast. Abdominal ultrasonography is Spence or a torn muscle belly(1). mandatory to exclude urogenital congenital Diagnosis of EBT is important because malformations that may be associated with ectopic breast tissue shows similar ectopic breast tissue. pathological changes that occur in normally 114 Sudan Med J 2014 August;50(2) Case Report Fibroadenoma in ectopic breast tissue Mohammed EH Azoz References 1. Harun C, Ertan B, Ozer A, Rana C. 8. Szu-pei Ho, Hui-hwa Tseng, TM King, Fibroadenoma of the ectopic breast of the Philip-C Chow. Anal phyllodes tumor in a axilla - a case report. Pol J Pathol 2006; male patient: a unique, case presentation 57(4):209-11. and literature review. Diagnostic 2. Coras B, Landthaler M, Hofstaedter F, Pathology 2013, 8:49. http://www.diag Meisel C, Hohenleutner U. Fibroadenoma nosticpathology.org/content/8/1/49 of the axilla. Dermatol Surg 2005;31: 9. Allen Gabriel M. Breast embryology. 1152-4. http://emedicine.med-scape.com/article/ 3. Burdick AE, Thomas KA, Welsh E, 1275146-overview#aw2aab6b8. Powell J, Elgart GW: axillary polymastia. 10. C. MB. The apocrine glands and the J Am Acad Dermatol 2003;49:1154-6. breast. New York: Wiley;1984.p.49-55. 4. Shin SJ, Sheikh FS, Allenby PA, Rosen 11.
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