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2</a>&#41;&#46; Histologic study showed a well circumscribed unencapsulated lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; composed of breast tissue with mildly dilated ductal lumina coated with a double layer of epithelial and myoepithelial cells&#46; Focal apocrine metaplasia of ductal epithelium was also observed&#46; The structure of the lobular population was preserved&#46; The stroma was fibrous and highly vascularized &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">An abdominal ultrasound allowed us to rule out associated malformations&#44; and a gynecological examination did not reveal any significant findings&#46; The outcome 2 months after surgery was satisfactory&#46; No other lesions were detected in the milk line or in the vulva&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Accessory mammary glands arise when milk line remnants outside the pectoral region fail to regress&#46; These abnormalities occur more frequently in women than men&#44; and are generally sporadic&#44; although familial forms have also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Different parts of the body can be involved&#44; but the axilla is the most common site&#44; accounting for 60&#37;&#8211;70&#37; of cases&#46; Vulvar or suprapubic involvement is extremely rare and few cases have been reported to date &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Lesions become symptomatic during menarche&#44; pregnancy&#44; and breastfeeding&#46; Cyclic fluctuations may arise&#44; coinciding with menstruation&#46; During pregnancy and breastfeeding&#44; the lesions may increase in size and lacteal secretion may occur&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Benign pathologic changes such as fibroadenomas&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> fibrocystic changes&#44; phyllodes tumor&#44; and intraductal papillomas have been reported&#46; Malignant lesions such as carcinomas&#44; adenocarcinomas&#44; and sarcomatous degeneration have also been reported&#44; although there is no evidence that these changes are more frequent in accessory breasts&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The presence of polythelia has also been associated with malformations and tumors in the urogenital tract&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The histopathology of these lesions shows glands with a typical cuboidal epithelial lining&#44; embedded in a fibrous stroma with a myoepithelial component&#46; Mammary parenchyma and an areola and nipple may also be present&#46; Currently&#44; distinction is made between ectopic breast tissue and mammary-like anogenital glands&#44; which are located at a more medial site close to the labia minora&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These structures are simpler and present in greater numbers&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">For vulvar lesions&#44; differential diagnosis includes vulvar carcinoma&#44; Bartholin gland disorders&#44; epidermal cyst&#44; and crural hernia&#46; Cyclic changes in size with menstruation or the onset of clinical manifestations during pregnancy or breastfeeding support diagnosis of an accessory breast and are usually the reason for the patient&#39;s visit&#46; A progressive increase in size due to the onset of associated neoplasms is also a common reason for seeking medical attention&#46; A histopathologic study is mandatory for confirmation of the clinical diagnosis and to rule out the presence of a neoplasm&#46; Ultrasound can be used to assess whether associated malformations or masses are present in the genitourinary tract&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the present case&#44; the patient had never been pregnant or breastfed and the histopathologic study revealed accessory breast tissue without any associated neoplasm&#46; Unlike most of the cases reported in the literature&#44; growth of the lesion was progressive with no apparent relationship to neoplastic changes or the oral contraceptive treatment started some years earlier&#46; This is therefore a rare case of a vulvar accessory breast that presented in a 24-year-old woman as a subcutaneous mass of unknown origin in which there was no clear hormonal trigger or tumor implicated in the sudden growth&#46; Differential diagnosis of vulvar lesions should include this entity&#46; The lesion itself should be excised due to the risk of malignant conversion of the ectopic tissue&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "xres95741"
          "titulo" => "Resumen"
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        3 => array:2 [
          "identificador" => "xpalclavsec82899"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case Report"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
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        8 => array:1 [
          "titulo" => "References"
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    ]
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    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec82900"
          "palabras" => array:3 [
            0 => "Breast"
            1 => "Ectopic"
            2 => "Vulva"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec82899"
          "palabras" => array:3 [
            0 => "Mama"
            1 => "Ect&#243;pica"
            2 => "Vulva"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We describe a 24-year-old woman with a subcutaneous swelling in the left inferior pubic region&#46; Histology revealed ectopic breast tissue&#46; Vulvar tumors are uncommon and the presence of ectopic breast tissue in this region is extremely rare&#46; In these cases&#44; patients usually consult for a mass that varies in size with hormonal changes&#44; typically during pregnancy or breast-feeding&#44; or that has associated neoplastic changes&#46; In our patient&#44; the mass had grown progressively with no identifiable underlying hormonal association or neoplasm&#46; We therefore classified it as ectopic breast tissue presenting as a subcutaneous mass&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se describe el caso de una mujer de 24 a&#241;os de edad con una tumoraci&#243;n subcut&#225;nea localizada en la regi&#243;n pubiana inferior izquierda cuyo estudio histopatol&#243;gico mostr&#243; una mama ect&#243;pica&#46; Las lesiones tumorales vulvares son poco frecuentes y la presencia de tejido mamario ect&#243;pico a nivel vulvar es extremadamente rara&#46; El motivo de consulta en estos casos suele ser el aumento de tama&#241;o fluctuante en relaci&#243;n con cambios hormonales&#44; generalmente secundarios al embarazo o la lactancia&#44; o con alteraciones tumorales asociadas&#46; El caso que se presenta mostraba un crecimiento progresivo sin aparente causa hormonal o neopl&#225;sica subyacente&#44; se trataba por tanto de una mama ect&#243;pica con cl&#237;nica de tumoraci&#243;n subcut&#225;nea&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Godoy-Gij&#243;n E&#44; et al&#46; Mama ect&#243;pica vulvar&#46; Actas Dermosifiliogr&#46; 2012&#58;229&#8211;32&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous mass in the left labium majus &#40;accessory breast&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Macroscopic view of the excised lesion&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Panoramic microscopic image of the lesion &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;10&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Microscopic image&#44; detail of the acini and ducts of the mammary tissue &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;10&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Clinical Manifestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progressive&#44; painful increase in size&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; nulliparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left pubic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periodic increase in size coinciding with menstrual cycle&#44; lacteal secretion and supernumerary nipple&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; nulliparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right pubic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mak et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progressive increase in size to 2<span class="elsevierStyleHsp" style=""></span>cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postmenopausal&#44; nulliparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left labium minus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">England<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size during gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdominal&#44; bilateral axillary&#44; and right vulvar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pathak and Preston<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size during premenstrual cycle and remitting with menstruation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right periclitoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duvvur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Painful increase in size during pregnancy and disappearance once breast feeding was finished&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right labium majus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bardsley and Petterson<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size during gestation and lacteal secretion during postpartum&#46; Supernumerary nipple&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; primigravida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left perineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size during gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilateral on labia majora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kapila et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Watchful waiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vulvodynia from 10 years of age</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postmenopausal&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilateral on labia majora and subclitoral</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cobellis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No sexual relationships or prior pregnancies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in size during lactation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left periclitoral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reeves and Kaufman<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Excision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Painless increase in size during gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of childbearing age&#44; multiparous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilateral on labia majora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Levin and Diener<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Partial vulvectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab182041.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Review of Cases Published to Date of Vulvar Accessory Breasts Without an Associated Tumor&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
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                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                  "contribucion" => array:1 [
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                  ]
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supernumerary nipple presenting as a vulvar mass in an adolescent&#58; case report and literature review"
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Journal Information
Vol. 103. Issue 3.
Pages 229-232 (April 2012)
Visits
24289
Vol. 103. Issue 3.
Pages 229-232 (April 2012)
Case report
Full text access
Accessory Breast on the Vulva
Mama ectópica vulvar
Visits
24289
E. Godoy-Gijóna,
Corresponding author
e.godoy.gijon@gmail.com

Corresponding author.
, M. Yuste-Chavesa, Á. Santos-Brizb, C. Esteban-Velascoc, P. de Unamuno-Péreza
a Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Clínico de Salamanca, Salamanca, Spain
b Servicio de Anatomía Patológica, Hospital Clínico de Salamanca, Salamanca, Spain
c Servicio de Cirugía General, Hospital Clínico de Salamanca, Salamanca, Spain
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Table 1. Review of Cases Published to Date of Vulvar Accessory Breasts Without an Associated Tumor.
Abstract

We describe a 24-year-old woman with a subcutaneous swelling in the left inferior pubic region. Histology revealed ectopic breast tissue. Vulvar tumors are uncommon and the presence of ectopic breast tissue in this region is extremely rare. In these cases, patients usually consult for a mass that varies in size with hormonal changes, typically during pregnancy or breast-feeding, or that has associated neoplastic changes. In our patient, the mass had grown progressively with no identifiable underlying hormonal association or neoplasm. We therefore classified it as ectopic breast tissue presenting as a subcutaneous mass.

Keywords:
Breast
Ectopic
Vulva
Resumen

Se describe el caso de una mujer de 24 años de edad con una tumoración subcutánea localizada en la región pubiana inferior izquierda cuyo estudio histopatológico mostró una mama ectópica. Las lesiones tumorales vulvares son poco frecuentes y la presencia de tejido mamario ectópico a nivel vulvar es extremadamente rara. El motivo de consulta en estos casos suele ser el aumento de tamaño fluctuante en relación con cambios hormonales, generalmente secundarios al embarazo o la lactancia, o con alteraciones tumorales asociadas. El caso que se presenta mostraba un crecimiento progresivo sin aparente causa hormonal o neoplásica subyacente, se trataba por tanto de una mama ectópica con clínica de tumoración subcutánea.

Palabras clave:
Mama
Ectópica
Vulva
Full Text
Introduction

Breast tissue is derived from the embryonic ectoderm. The so-called milk line extends from the axilla to the medial aspect of the groin.1 During embryogenesis, this tissue undergoes spontaneous regression except in the chest region, where it gives rise to breasts in adults.

When regression of milk line remnants fails to occur outside the pectoral region, accessory breast structures may arise. These are observed most frequently in the axillary region and only rarely at a vulvar site.1

Case Report

We report the case of a 24-year-old woman who was assessed in a visit to the dermatology department for vulvar swelling that had began 2 years earlier and had become progressively worse in the 6 months prior to the visit. Initially, the patient had been seen in the gynecology department, where a tentative diagnosis of lipoma was made and watchful waiting indicated.

The patient had no personal or family history of similar lesions. She had never been pregnant and the progressive growth of the lesion was not linked to her menstrual cycle although, during premenstruation, she did describe a tense sensation that remitted on menstruation. Her only concomitant medication was an oral contraceptive (ethinylestradiol and chlormadinone acetate), which she had been taking for 4 years.

Clinical examination revealed a subcutaneous mass measuring 1.5cm in diameter that was palpable but hardly visible, elastic and mobile, and not adhered to the deep layers (Fig. 1). The overlying skin was normal. The patient reported mild pain on palpation. No enlarged lymph nodes were detected in the groin region.

Figure 1.

Subcutaneous mass in the left labium majus (accessory breast).

(0.1MB).

The lesion was excised (enucleation) with the patient under local anesthetic and sedation. During the surgical procedure, it was observed that the mass occupied the entire labium majoris and extended deeply, measuring 4.5cm×2.5cm×2.5cm, much larger than thought in the initial examination.

Macroscopic examination revealed a highly vascularized nodular lesion resembling a tumor, with polylobulated ovoid morphology and a thin fibrous pseudocapsule. Sectioning revealed a homogeneous pink-brown elastic surface of fibrous appearance with no necrotic foci (Fig. 2). Histologic study showed a well circumscribed unencapsulated lesion (Fig. 3) composed of breast tissue with mildly dilated ductal lumina coated with a double layer of epithelial and myoepithelial cells. Focal apocrine metaplasia of ductal epithelium was also observed. The structure of the lobular population was preserved. The stroma was fibrous and highly vascularized (Fig. 4).

Figure 2.

Macroscopic view of the excised lesion.

(0.14MB).
Figure 3.

Panoramic microscopic image of the lesion (hematoxylin–eosin, original magnification ×10).

(0.41MB).
Figure 4.

Microscopic image, detail of the acini and ducts of the mammary tissue (hematoxylin–eosin, original magnification ×10).

(0.26MB).

An abdominal ultrasound allowed us to rule out associated malformations, and a gynecological examination did not reveal any significant findings. The outcome 2 months after surgery was satisfactory. No other lesions were detected in the milk line or in the vulva.

Discussion

Accessory mammary glands arise when milk line remnants outside the pectoral region fail to regress. These abnormalities occur more frequently in women than men, and are generally sporadic, although familial forms have also been reported.2 Different parts of the body can be involved, but the axilla is the most common site, accounting for 60%–70% of cases. Vulvar or suprapubic involvement is extremely rare and few cases have been reported to date (Table 1).2

Table 1.

Review of Cases Published to Date of Vulvar Accessory Breasts Without an Associated Tumor.

Case  Clinical Manifestation  Age    Site  Reference  Treatment 
Progressive, painful increase in size  18  Of childbearing age, nulliparous  Left pubic  Hong et al.2  Excision 
Periodic increase in size coinciding with menstrual cycle, lacteal secretion and supernumerary nipple  17  Of childbearing age, nulliparous  Right pubic  Mak et al.7  Excision 
Progressive increase in size to 2cm  45  Postmenopausal, nulliparous  Left labium minus  England8  Excision 
Increase in size during gestation  31  Of childbearing age, multiparous  Abdominal, bilateral axillary, and right vulvar  Pathak and Preston1  Excision 
Increase in size during premenstrual cycle and remitting with menstruation  41  Not reported  Right periclitoral  Duvvur et al.9  Excision 
Painful increase in size during pregnancy and disappearance once breast feeding was finished  31  Of childbearing age, multiparous  Right labium majus  Bardsley and Petterson10  Excision 
Increase in size during gestation and lacteal secretion during postpartum. Supernumerary nipple.  20  Of childbearing age, primigravida  Left perineal  Basu et al.11  Excision 
Increase in size during gestation  30  Of childbearing age, multiparous  Bilateral on labia majora  Kapila et al.12  Watchful waiting 
9Vulvodynia from 10 years of age53Postmenopausal.  Bilateral on labia majora and subclitoralCobellis et al.13Excision
No sexual relationships or prior pregnancies 
10  Increase in size during lactation  29  Of childbearing age, multiparous  Left periclitoral  Reeves and Kaufman14  Excision 
11  Painless increase in size during gestation  29  Of childbearing age, multiparous  Bilateral on labia majora  Levin and Diener15  Partial vulvectomy 

Lesions become symptomatic during menarche, pregnancy, and breastfeeding. Cyclic fluctuations may arise, coinciding with menstruation. During pregnancy and breastfeeding, the lesions may increase in size and lacteal secretion may occur.

Benign pathologic changes such as fibroadenomas,3 fibrocystic changes, phyllodes tumor, and intraductal papillomas have been reported. Malignant lesions such as carcinomas, adenocarcinomas, and sarcomatous degeneration have also been reported, although there is no evidence that these changes are more frequent in accessory breasts.2 The presence of polythelia has also been associated with malformations and tumors in the urogenital tract.4,5

The histopathology of these lesions shows glands with a typical cuboidal epithelial lining, embedded in a fibrous stroma with a myoepithelial component. Mammary parenchyma and an areola and nipple may also be present. Currently, distinction is made between ectopic breast tissue and mammary-like anogenital glands, which are located at a more medial site close to the labia minora.6 These structures are simpler and present in greater numbers.

For vulvar lesions, differential diagnosis includes vulvar carcinoma, Bartholin gland disorders, epidermal cyst, and crural hernia. Cyclic changes in size with menstruation or the onset of clinical manifestations during pregnancy or breastfeeding support diagnosis of an accessory breast and are usually the reason for the patient's visit. A progressive increase in size due to the onset of associated neoplasms is also a common reason for seeking medical attention. A histopathologic study is mandatory for confirmation of the clinical diagnosis and to rule out the presence of a neoplasm. Ultrasound can be used to assess whether associated malformations or masses are present in the genitourinary tract.

In the present case, the patient had never been pregnant or breastfed and the histopathologic study revealed accessory breast tissue without any associated neoplasm. Unlike most of the cases reported in the literature, growth of the lesion was progressive with no apparent relationship to neoplastic changes or the oral contraceptive treatment started some years earlier. This is therefore a rare case of a vulvar accessory breast that presented in a 24-year-old woman as a subcutaneous mass of unknown origin in which there was no clear hormonal trigger or tumor implicated in the sudden growth. Differential diagnosis of vulvar lesions should include this entity. The lesion itself should be excised due to the risk of malignant conversion of the ectopic tissue.

Conflicts of Interest

The authors declare no conflicts of interest.

References
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Ectopic breast tissue presenting as a persistent vulval swelling in a primary care minor surgery clinic: a case report and review of the literature.
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Ectopic breast tissue of the vulva.
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Ectopic breast tissue presenting as a persistent vulval cyst.
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Accessory breast in the perineum.
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Vulvar ectopic breast tissue mimicking periclitoral abscess.
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N. Levin, R.L. Diener.
Bilateral ectopic breast of the vulva. Report of a case.
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Please cite this article as: Godoy-Gijón E, et al. Mama ectópica vulvar. Actas Dermosifiliogr. 2012:229–32.

Copyright © 2010. Elsevier España, S.L. and AEDV
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