Ectopic Breast Fibroadenoma

摘要

The presence of extra nipples (polythelia) and breasts (polymastia) is not uncommon. Although often found within the milk line, running from the axilla to the groin or pubic region, there are descriptions in which they occur elsewhere, in atypical localizations such as vulva and torso. The authors report a case of ectopic breast fibroadenoma in the pubic region, which was surgically excised. Introduction The presence of extra nipples (polythelia) and breasts (polymastia) is not uncommon. The genesis of this breast tissue lies in quiescent primordial cells that, although occur more often along “Hughes lines” (mammary lines or “milk lines”) supernumerary, it can also have an ectopic location. There are rare, unusual locations, usually referred as “mammae erraticae”: buttock, back of neck, face, flank, upper arm, hip, shoulders and midline of the back and chest. It can occur in males, but it is far much more common in females. Wherever it occurs, this ectopic breast tissue can undergo the same pathologic changes as normally positioned breasts, such as fibroadenomas and carcinomas.Although polythelia is congenital in origin, polymastia and ectopical mammary tissue may not appear until enhanced by sex hormones during specific periods of female life, such as puberty, pregnancy and puerperium (if breast feeding the child). This ectopic breast tissue can undergo the same pathologic changes as normally positioned breasts. Cases of ectopic breasts with benign cystic changes, benign tumors (adenomas and fibroadenomas) and carcinomas are documented.The association of supernumerary breast tissue and increased fertility suggested by fertility goddesses of the ancients like Artemis of Ephesus, or mentioned in the 19 th century medical literature has been proven false. The only evidence that clearly exists is the association between the presence of supernumerary breast tissue (particularly polythelia) and various anomalies of the urinary tract, a fact that can be explained by the simultaneous embryologic development of both mammary parts and the urinary system.The ectopic tissue can be surgically excised if symptomatic or if it represents a cosmetic problem. In cases of carcinoma, wide surgical excisions are recommended. The clinical workup and appropriate therapies need to be finetuned in cases of ectopic breast tissue.In this article, we present a case report of an ectopic breast fibroadenoma which was at the pubic region. Case report A 37 years old female who had an elongated mass, 10 x 5 centimeters of diameter, smooth and elastic in consistency, localized in the pubic region. This mass had been noticed for the first time about 6 years ago and had been growing since then. The only additional complaint was local pruritus.She had a female phenotype. The pubic hair distribution and secondary sexual characters were normal, so was the gynecological exam.She was a schizophrenic patient under neuroleptic medication (flufenazine and clozapine) and had smoking habits ( 20 - 30 cigarettes per day). In her gynecological history, our patient had menarche at 12 years old, regular menstrual cycles of 30 days cycle and 6 days duration. Regarding her obstetric history, she had two voluntary pregnancy interruptions, free of intercurrences, and underwent bilateral tubal ligation at 21 years old.Her mother revealed that there was no one else in the family with similar masses nor any mass suspicious of being supernumerary breast tissue.Several complementary examinations were done: analytic blood tests, including hormone determinations, which had all normal results, and ultrasonographic exam of the urinary system, which was also normal.The excision of the lesion was done under general anesthesia. There were no complications in the post-operative period. The anatomical-pathological diagnosis was of breast fibroadenoma.