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Cukurova Medical Journal Cukurova Medical Journal Araştırma Makalesi / Research Article A Tale of Axillary Tail of Breast Memenin Aksiller Ucunun Hikayesi Smita Sankaye1, Sushil Ghanshyam Kachewar1 1Rural Medical College, PIMS(DU), Loni, Ta-Rahata, Ahmednagar Maharashtra, INDIA Cukurova Medical Journal 2014; 39 (3):540-545. ABSTRACT This original article tells the tale of the axillary tail of the breast. Human breast`s parenchymal extension into the axilla is known as the axillary tail of the breast. Normally, it remains confined as per the healthy individual’s body habitus. But sometimes it may become prominent and thereby a cause of tension. A plethora of findings have been reported to occur in an axillary tail. From toxoplasma to tumors, the list is comprehensive. Hence, each individual with a prominent axillary tail has its own tale to tell as has been explained in this article. Pathologists as well as Radiologists should be well aware of the various normal and abnormal entities affecting it, so that the distressed individual seeking assistance is properly managed. Key Words: Breast,Pathology,Axillary Tail,Mastopathy ÖZET Bu orjinal makale meme aksiller ucunun hikayesini anlatmaktadır. Koltuk altına ulaşan insan memesinin parenkimal uzantısı memenin aksiller ucu olarak bilinir. Normalde, sağlıklı insan vücudunun bir parçası olarak karşımıza çıkar ancak bazen önemli ve ayrıca tansiyon nedeni olabilmektedir. Bulguların çoğunun aksiller ucundan geldiği rapor edilmiştir. Toksoplazmadan tümörlere kadar oldukça kabarık bir liste bulunmaktadır. Bu yüzünden; çıkık aksiller uçlu her bireyin kendine özgü hikayesi bulunmaktadır. Radyologların yanı sıra patologların aksiller ucu etkileyen farklı normal ve anormal durumlardan haberleri olmalı ki bu konuda destek arayan sıkıntılı bireylerin doğru yönlendirilmeleri yapılabilsin. Anahtar Kelimeler: Meme, Patoloji Aksiller uç, Mastopati, factors, so are the morphologic characters of the INTRODUCTION axillary tail. Usually it extends along the infero- The extension of the normal parenchyma of lateral edge of the pectoralis major muscle2,3. the breast into the axilla is known as the axillary Normal axillary tail is asymptomatic. But an tail of the breast. It is also known as the Tail of individual may become symptomatic or concerned Spence (Spence's tail) after James Spence the as soon as it becomes prominent or as soon as it 1 renowned Scottish surgeon . hosts a pathology. Since it is an extension of It is present in both males as well as females. breast tissue, all diseases that can affect breast, The females have them far well-developed than can also affect this tail. It is therefore essential that medical professionals are aware and alert about it. males. As the breast size and shape are the DISCUSSION outcome of dietary, genetic and environmental 540 Sankaye and Kachewar Cukurova Medical Journal An individual may present with an axillary It is therefore important that the reporting swelling in following scenarios: pathologist reports whether the prominent soft 1. Lumpy feeling in Axillary Tail- tissue bulge in axilla is due to enlarged axillary tail Many healthy females have this common or ectopic location of breast tissues of the milk complaint. Although there is no palpable discrete ridge. solid or cystic mass in their axilla, it is the inner 2. Palpable Mass in the Axillary Tail- feeling or the external appearance that brings them As the "axillary tail of Spence” extends into to seek medical opinion for the same. the axilla, any pathology that can present in breast; As shown in Figure 1, a healthy female of 43 can manifest in axillary tail as well. The importance years of age came with the complaint of lumpy of this principle lies in the realization that a mass in feeling in both axillae. Prominent soft tissue bulge axillary tail; although might not seem to be in the was seen in both axillae [A and B]. High resolution breast proper, can still be a breast mass. ultrasound [HRUSG] with 7.5 MHz linear Chronic infective conditions like Tuberculosis transducer showed normal breast parenchymal can occur in the axillary tail8,9. HRUSG as well as x appearance below this axillary lump (C). It had ray mammogram may demonstrate an abnormality normal vascularity. Fine needle aspiration cytology but cannot confirm whether it is infective- [FNAC] in this region yielded normal breast inflammatory or neoplastic. A strong clinical parenchymal microscopic appearance (D) as seen suspicion of tuberculosis of axillary tail of breast, on low power field. The patient was counselled followed by FNAC along with ZN stained smear about the normalcy and discharged. preparation and PCR are the essential In some other patients when this normal prerequisites for early diagnosis. Figure 2 shows a axillary tail becomes prominent, the affected case of tuberculosis. The skin (2A) had a cystic individuals describe them differently as “although palpable lump in right axillary tail. HRUSG (2B) not damaging not very uncomfortable and painful showed necrotic areas within, confirmed of at certain times of the month and quite unsightly as harboring Acid Fast Bacilli (2C) in the collection a 'bulge' out of their armpits which looked like fat!” that also demonstrated the appearance of In such conditions, some active intervention may granulomatous (2D) lesion on low power image. be needed. Pathologist`s opinion on FNAC can Toxoplasmosis too can manifest as a solve the issue by giving proper diagnosis4. palpable mass in the axillary tail of the breast10,11. Lactation has been described to occur from HRUSG and X-ray mammography might raise a the axillary tail of breast5, and may be quite suspicion of pathological process but usually are distressing. not conclusive. FNAC and core biopsy of the Differentiation of accessory breast tissue in lesions can rule out a malignancy and display the the axilla from the axillary tail of breast is also underlying granulomatous lesion favoring necessary and possible (6, 7). Although toxoplasmosis. Serological workup for Toxoplasma Accessory or Ectopic Axillary Breast Tissue is not gondii can confirm the diagnosis11. common, it is a common in polymastia. The Benign processes like different types of accessory axillary breast tissue usually becomes Breast cysts and Fibroadenomas can present as noticeable in peripubertal period puberty. The palpable mass in the axilla. Diabetic mastopathy12 opinion about its origin is diverse. On one side it and Antiretroviral therapy associated may truly be an ectopic tissue not contiguous with mastopathy(13) too can present as palpable the breast. It may also be the prominent the axillary masses. axillary tail6,7. Malignant neoplasms too can involve the axillary tail14,15. These malignancies may either be 541 Cilt/Volume 39 Yıl/Year 2014 Axillary Tail of Breast primary or Secondaries. The axillary tail may be Imaging and Positron Emission Tomography may involved by primary squamous cell carcinoma, be needed for complete pre-operative evaluation. which may be frankly manifest or be occult and It has to be kept in mind that in almost all may present clinically as an isolated axillary lymph these conditions, the final diagnosis rests with the node mass. Figure 3 shows a case of intra-ductal Pathologist. Armed with FNAC and Biopsy along carcinoma that arose in axillary tail. The skin (3A) with various immuno-histo-chemical analyses, had a firm palpable lump in right axillary tail. FNAC exact diagnosis can be made. Wherever local revealed the intra ductal carcinoma on low power expert facilities are not available help of (3B) as well as high power (3D) field. The mass telepathology may be obtained for reaching the was well appreciated on HRUSG (3C). diagnosis18. Apocrine cystadenomas is another interesting Management of tale of axillary tail of breast: entity that can affect the axillary tail. In this Management depends on the etiology. condition, the apocrine glands undergo benign Treatment of asymptomatic condition – adenomatous cystic proliferations manifesting as Patients may be uncomfortable about the palpable cystic lesions in the axilla. Diagnosis is appearance of their axilla. The axillary lump might made by the Pathologist by identifying the be painful at certain times of the month. lipofuscin granules that are present inside the Medications to relieve pain and proper counselling apocrine cells contained, which were and are are important in this condition. Elective surgery characteristically diastase resistant and Periodic may be carried out for cosmetic purposes. acid Schiff (PAS) positive16. Treatment of symptomatic conditions – To complete the tale of the pathologies that Infective condition needs proper medications. can affect the axillary tail, rare entity known as Tuberculosis of breast needs anti-tubercular Giant cell arteritis must also be kept in mind17. It chemotherapy and surgery for draining breast can present as a new lump in axillary region which abscesses, excising residual sinus tracts and even on x ray mammogram may show mixed density lumps in cases with poor response to anti- breast tissue that may eventually subside and stay tuberculosis therapy19,20. as a string-like thickening in axillary tail. HRUSG For toxoplasmosis Spiramycin may be may show thick walled arteries in the axillary tail. administered as it can even reduce the risk of Erythrocyte sedimentation rate and C-reactive foetal infection from an infected mother. protein are significantly raised. Arterial biopsy is Sulfadiazine-pyrimethamine combination is diagnostic. administered for individuals with impaired An Approach to correct Diagnosis immunity10,11. In order to make the correct diagnosis of the Prednisolone is used in cases of Giant Cell pathology affecting axillary tail, proper history and Arteritis. clinical examination form the first step. For benign distressing lumps and well as for History of fever, tenderness and discharge local malignant lumps in axillary tail, excisional from the swelling can indicate an infective etiology lumpectomy is the way out. This may be followed like Tuberculosis. Long standing nodular mass by appropriate chemotherapy if needed. It has to indicates neoplasm. be remembered that complete removal of breast Next comes the role of imaging.
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