Ectopic breast tissue in the vulva masquerading as an abscess

Abstract

Dear Sir, Ectopic breast tissue (EBT) along the embryonic milk lines is reported to be more common in Asian women. Hormonal changes associated with puberty, pregnancy or lactation can result in functional activity within the dormant glandular tissue, leading to symptoms. We describe the case of a 34-year-old Chinese woman who presented with a suspected vulvar abscess. Based on our literature search, this is the first case of vulvar EBT presenting as an abscess.The patient presented with a three-week history of left vulvar swelling. Although she had noted the vulvar swelling for the past two years, there had been a substantial increase in its size, accompanied by pain and discharge, over the past three weeks. She had undergone a lower-segment Caesarean section one month prior to this presentation and was currently breastfeeding a healthy baby. On examination, the patient was afebrile, and an erythematous, tender, fluctuant left labia majora swelling (5 cm × 4 cm) with purulent discharge was observed. She was diagnosed with a vulvar abscess and underwent incision and drainage under local anaesthesia. Intraoperatively, a cystic lesion of the left labia that contained whitish purulent material was evident. The entire cyst wall was excised and sent for histology. The histology report showed EBT with lactational changes and acute-on-chronic inflammation (Fig. 1). Postoperatively, she recovered well and was managed with dressing in the outpatient setting. Three months after surgery, she was seen in the outpatient clinic. On physical examination, the wound had healed with no ectopic tissue identified anywhere along the milk lines, and she was discharged from follow-up.Early in the development of the embryo, two lines develop along its lateral aspects stretching from the axilla to the groin. These lines develop into mammary ridges, which will be the future site of the breasts. Most of these ridges regress under normal circumstances except for imminent breast tissue. EBT is a congenital anomaly in which abnormal additional breast tissue is present along the mammary/milk lines. This occurs more frequently in females and is more common among Asians compared to Caucasians. According to one study, the incidence of EBT can be as high as 5% in Japanese females. (1) There is some evidence that this condition may be inherited. (2) EBT remains asymptomatic until the patient is under the hormonal influences of puberty, pregnancy or lactation. (3) Copeland and Geschickter classified EBT with an accessory nipple or areolar formation with or without glandular tissue as supernumerary breast. EBT without a nipple or areolar complex is classified as aberrant breast tissue. (4) The most common site is the axilla, which accounts for 60%-70% of the cases. Vulval EBT is extremely rare, with only 12 cases (5) reported thus far, based on a literature search.EBT manifests all the different features of normal breast tissue such as growth during puberty, pregnancy and lactation, as well as pathologies such as benign and malignant tumours. (6) EBT ...

Tejido mamario ectópico en vulva: reporte de caso y revisión sistemática de la literatura

“…Canadá 78 , 79 , Japón 80 , 81 , Corea del Sur 82 , 83 , Israel 84 , 85 , Arabia Saudita 86 , 87 y Kuwait 88 , 89 tienen 2 reportes de caso cada uno. Por otra parte, Alemania 90 , Francia 91 , Croacia 92 , Austria 93 , Holanda 94 , Grecia 95 , Suiza 96 , Portugal 97 , Eslovenia 98 , Serbia 99 , Cuba 100 , México 101 , Singapur 102 , Irán 103 , Baréin 104 , Nigeria 105 , Túnez 106 , Brasil 107 , Colombia 108 y Chile 109 aportan 1 caso cada país.…”

“…En el grupo de patología benigna, al momento de vida del diagnóstico (estado hormonal), el 56,1 % (41/73) se encontraba en edad fértil ( (21,22,35,47,48,61,78,82,89,91,105); un 12,3% (9/73) en período postparto (18,24,42,52,67,86,93,94,102); una en lactancia (106); un 10,9% (8/73) se encontraba en postmenopausia (19,28,45,46,57,69,70); y un caso sin datos (26).…”

Fibroadenoma Presenting as a Vulvar Mass

“…There is limited literature describing ectopic breast tissue in the vulva presenting as an enlarging mass over time. 2,10,13,20 One report specifically described vulvar ectopic breast tissue presenting as an abscess with pain and discharge, as well as vulvar swelling that had increased in size over the course of two years. 10 In our case, the patient has not had any recurrence of symptoms to date; however, recurrent vulvar breast fibroadenoma has been reported in the literature and estimated to be around 3%.…”

“…2,10,13,20 One report specifically described vulvar ectopic breast tissue presenting as an abscess with pain and discharge, as well as vulvar swelling that had increased in size over the course of two years. 10 In our case, the patient has not had any recurrence of symptoms to date; however, recurrent vulvar breast fibroadenoma has been reported in the literature and estimated to be around 3%. 3 Based on this report, masses that were greater than 2 cm or masses with incomplete removal were associated with higher risks of recurrence, so further surveillance and close follow-up is warranted for larger masses and those with concerning features.…”

“…While vulvar masses associated with pregnancy and recurrence have been reported previously in the literature, this case was unique as the cause of this vulvar mass is unknown and completely random, with no associated conditions or correlation with pregnancy, lactation, or menstrual cycles or previous history of malignancy. 1,2,10,11…”