Fibroadenoma in Axillary Supernumerary Breast In A 17 Years Old Girl: Case Report

Adrian Surd; Rodica Muresan; Horatiu Gocan

doi:10.4172/2376-127X.1000178

ISSN: 2376-127X

Journal of Pregnancy and Child Health

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Fibroadenoma in Axillary Supernumerary Breast In A 17 Years Old Girl: Case Report

Adrian Surd, Rodica Muresan, Horatiu Gocan^*
Emergency Children’s Hospital, Department of Pediatric Surgery, Cluj-Napoca, Romania
Corresponding Author :	Horatiu Gocan Emergency Children’s Hospital Department of Pediatric Surgery Cluj-Napoca, Romania Tel: +40 264597706 E-mail: horatiugocan@yahoo.com
Received June 17, 2014; Accepted July 08, 2015; Published July 10, 2015
Citation: Surd A, Muresan R, Gocan H (2015) Fibroadenoma in Axillary Supernumerary Breast In A 17 Years Old Girl: Case Report. J Preg Child Health 2:178. doi: 10.4172/2376-127X.1000178
Copyright: © 2015 Surd A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Introduction: Supernumerary breast or polymastia is a well-documented anomaly of the breast, and commonly presents along the embryonic milk line extending between the axilla and groin. However, cases of polymastia have been recorded in the face, vulva and perineum. The clinical significances of these anomalies include their susceptibility to inflammatory and malignant changes, and their association with other congenital anomalies of the urinary and cardiovascular systems.

Case report: The present article reports a case of fibroadenoma developing in the supernumerary breast of the right axilla in a 17 year old girl. It is uncommon to find such palpable masses in young patients Clinical and sonographic examination of both breasts revealed no abnormalities and no lymph nodes were detected in the axillae or the neck. No associated urologic or cardiovascular abnormalities were found, and the histopathological examination of the excisional biopsy samples showed a well-defined, capsulated intracanalicular type of fibroadenoma similar to that of eutopic mammary tissue.

Discussion: We have described a rare case of fibroadenoma in an accessory breast in a young woman. There are a fewer than 40 reports in world about this subject of which differential diagnose include cancer in axillary supernumerary breast, hidradenitis, axillary lymphadenomegaly, lipomas, anexial cutaneous neoplasia, cysts and phylloid tumor. The combination of clinical examination, ultrasound and cytology leads to adequate treatment, especially surgical one. The investigation could be confused owing to the suspicious findings from cytology. In this case, in the fact of the findings and differential diagnosis, the histopathological study has concluded the diagnosis. Despite of its high sensitivity, the cytology has a low specificity and could create positive false. On the other hand, atypical lesions can be seen in fibroadenomas, especially in younger patients, pregnant one and hormonal contraception use. Although there are a few reports, our case report is similar to current medical registers and, after surgical treatment, it possesses an excellent prognoses.

Keywords

Supernumerary breast; Fibroadenoma; Histopathology; Axilla

Introduction

“Polymastia” is a term that is used to de scribe the presence of more than two breasts with or without a nipple and areola in human beings. It is synonymous with supernumerary or accessory breast (EBT) tissue. Ectopic breast tissue occurs anywhere along the primitive embryonic milk lines, which extend from the axilla to the groin, and may occur unilaterally orbilaterally [1,2]. Axillary breast tissue is a common variant of EBT, with a reported incidence of 2 to 6% in women [3]. It is twice as common in female patients as in males [2]. It can be seen during or before puberty, and is often noted during pregnancy [2]. Normally, ectopic breast tissue appears sporadically. However, it is suspected that it may also be a hereditary condition [3].

Diagnosis of EBT is important because ectopic breast tissue shows similar pathologic changes that occur in normally positioned breasts and can be a marker for urologic malformations or urogenital malignancies [4,5]. We present a case of a 17-year-old girl with a subcutaneous tumor in the axilla that was histologically identical to the fibroadenomas seen in the breast.

Case report

A 17 year-old girl was ad mitted because of a 4 × 3 ×2.5 cm right axillary mass, which had first appeared 2 years earlier. The mass increased in size within the past year. The mass was painless, firm, freely mobile and completely isolated from the right breast. Both breasts and nipples were clinically normal, and there were no lymph nodes in the axillae and neck. The ultrasound revealed a homogenous 3x3 hypoechoic mass. The patient had no personal or family history of breast cancer.

The entire mass was removed surgically. Macroscopically the suspicion was of lipoma (Figure 1). Histopathological examination of the sections taken from different levels of the sample showed a welldefined capsule with multiple septa dividing the lesion into several lobules. Each lobule consisted of several interconnected ductules lined by cuboidal epithelial cells resting on the myoepithelial cells layer and surrounded with plenty of mesenchymal loose fibro-collagenous tissue. Occasionally, isolated epithelial-lined small cysts were also observed. The histopathological picture was of intracanalicular type of fibroadenoma similar to the conventional type arising in normal breast tissue (Figure 2).

Discussion

During the early weeks of embryonic development, the mammary milk lines, which represent two ectodermal two thickenings along the sides of the embryo, extend from the axillary region to the groin. In normal development, most of the embryologic mammary ridges resolve, except for two segments in the pectoral region, which later become the breast. A failure of any portion of the mammary ridge to involute may lead to ectopic breast tissue with (polythelia) or without (polymastia) a nipple/areolar complex [6,7].

Polythelia, in particular, has been associated with urinary anom lies, such as supernumerary kidneys, failure of renal formation, and renal carcinomas, which can be explained in part by the parallel embryologic development of mammary structures and the genitourinary system [4,7]. Most instances of ectopic breast tissue occur along the milk line in the axilla [1]. Ectopic breast tissue has been reported in areas other than the milk line region, such as the perineum, face and vulva [1,6]. Two hypotheses have been proposed on the embryogenesis of the supernumerary breast. One attributes the anomaly to the failure of regression and displacement of the milk line, while the other believes it develops from the modified apocrine sweat glands [1].

As compared to pectoral breast tissue, EBT demonstrates the same hormonal effects and is at risk of developing breast diseases. During menses or pregnancy, hormonal stimulation may cause enlargement and discomfort. EBT can undergo lactational changes during pregnancy, and in the presence of a nipple-areolar complex, it can give rise to lactational secretion [7]. The clinical differential diagnosis for a solitary axillary mass is very broad. In addition to ectopic breast tissue, it includes primary malignancies, benign cutaneous or subcutaneous tumors, and infectious and vascular lesions, as well as an axillary tail of Spence or a torn muscle belly. The diagnosis of ectopic breast tissue is strongly suggested by the history of cyclic changes during the menstrual period or by the initial appearance during pregnancy. The diagnosis can be established in case of lactation during the puerperium [1,3]. Fibroadenomas are relatively frequent, being the most common benign neoplasm of the breast, generally appearing as well-circumscribed, painless masses in young women [3]. Histologically, they constitute mixed neoplasms with epithelial and non-epithelial components. The epithelial proliferation usually shows ducts of variable shapes and sizes lined by two layers of epithelial and myoepithelial cells. Apocrine metaplasia, squamous metaplasia, or intraductal epithelial hyperplasia may be seen occasionally. The non-epithelial components show variable degrees of cellularity and collagenization [1]. Ectopic breast tissue is subject to hormonal response and may develop benign and malignant pathologic processes similar to those seen in normally located breast tissues, including fibrocystic disease, fibroadenoma, intraductal papilloma, lactating adenoma and carcinoma [2,3,7]. Ectopic breast is common in masses in the axilla and malignant and benign tumors may develop from this lesion. One of the benign lesions is also fibroadenoma, but its location in the axilla is rare. Fibroadenoma originating from an ectopic breast should be taken into consideration in the differential diagnosis of axillary masses.