Case report
Accessory Breast on the Vulva
Mama ectópica vulvar
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"apellidos" => "Esteban-Velasco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "de Unamuno-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Clínico de Salamanca, Salamanca, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico de Salamanca, Salamanca, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía General, Hospital Clínico de Salamanca, Salamanca, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mama ectópica vulvar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 105862 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous mass in the left labium majus (accessory breast).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Breast tissue is derived from the embryonic ectoderm. The so-called milk line extends from the axilla to the medial aspect of the groin.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> During embryogenesis, this tissue undergoes spontaneous regression except in the chest region, where it gives rise to breasts in adults.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical examination revealed a subcutaneous mass measuring 1.5<span class="elsevierStyleHsp" style=""></span>cm in diameter that was palpable but hardly visible, elastic and mobile, and not adhered to the deep layers (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The overlying skin was normal. The patient reported mild pain on palpation. No enlarged lymph nodes were detected in the groin region.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">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 4.5<span class="elsevierStyleHsp" style=""></span>cm×2.5<span class="elsevierStyleHsp" style=""></span>cm×2.5<span class="elsevierStyleHsp" style=""></span>cm, much larger than thought in the initial examination.</p><p id="par0035" class="elsevierStylePara elsevierViewall">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 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Histologic study showed a well circumscribed unencapsulated lesion (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) 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 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</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, 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.</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. These abnormalities occur more frequently in women than men, and are generally sporadic, although familial forms have also been reported.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 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 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<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, 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.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Benign pathologic changes such as fibroadenomas,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> 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.<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.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These structures are simpler and present in greater numbers.</p><p id="par0065" class="elsevierStylePara elsevierViewall">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.</p><p id="par0070" class="elsevierStylePara elsevierViewall">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.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres95740" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82900" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95741" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82899" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "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" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82899" "palabras" => array:3 [ 0 => "Mama" 1 => "Ectópica" 2 => "Vulva" ] ] ] ] "tieneResumen" => true "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. 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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Godoy-Gijón E, et al. Mama ectópica vulvar. Actas Dermosifiliogr. 2012:229–32.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 105862 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subcutaneous mass in the left labium majus (accessory breast).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 142424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Macroscopic view of the excised lesion.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1297 "Ancho" => 900 "Tamanyo" => 427568 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Panoramic microscopic image of the lesion (hematoxylin–eosin, original magnification ×10).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 716 "Ancho" => 950 "Tamanyo" => 271311 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Microscopic image, detail of the acini and ducts of the mammary tissue (hematoxylin–eosin, original magnification ×10).</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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 \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 \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 \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"> \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 \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 \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 \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 \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, painful increase in size \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 \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, nulliparous \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 \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.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \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 \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 \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, lacteal secretion and supernumerary nipple \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 \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, nulliparous \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 \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.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \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 \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 \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 \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 \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, nulliparous \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 \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> \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 \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 \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 \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 \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, multiparous \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, bilateral axillary, and right vulvar \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> \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 \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 \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 \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 \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 \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 \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.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \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 \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 \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 \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 \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, multiparous \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 \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> \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 \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 \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. Supernumerary nipple. \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 \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, primigravida \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 \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.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \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 \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 \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 \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 \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, multiparous \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 \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.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> \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 \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. \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.<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 \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 \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 \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 \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, multiparous \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 \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> \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 \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 \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 \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 \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, multiparous \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 \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> \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182041.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Review of Cases Published to Date of Vulvar Accessory Breasts Without an Associated Tumor.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of multiple accessory breast tissue in the axillae, lower abdomen and vulval areas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. 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| Year/Month | Html | Total | |
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| 2024 October | 85 | 65 | 150 |
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| 2024 May | 83 | 43 | 126 |
| 2024 April | 102 | 23 | 125 |
| 2024 March | 86 | 29 | 115 |
| 2024 February | 89 | 27 | 116 |
| 2024 January | 92 | 27 | 119 |
| 2023 December | 91 | 24 | 115 |
| 2023 November | 70 | 30 | 100 |
| 2023 October | 67 | 25 | 92 |
| 2023 September | 61 | 38 | 99 |
| 2023 August | 38 | 26 | 64 |
| 2023 July | 93 | 31 | 124 |
| 2023 June | 67 | 23 | 90 |
| 2023 May | 86 | 38 | 124 |
| 2023 April | 80 | 24 | 104 |
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| 2022 December | 90 | 49 | 139 |
| 2022 November | 56 | 31 | 87 |
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| 2022 August | 55 | 45 | 100 |
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| 2022 May | 123 | 44 | 167 |
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| 2021 December | 67 | 52 | 119 |
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| 2021 May | 105 | 45 | 150 |
| 2021 April | 193 | 71 | 264 |
| 2021 March | 123 | 34 | 157 |
| 2021 February | 118 | 25 | 143 |
| 2021 January | 83 | 26 | 109 |
| 2020 December | 54 | 21 | 75 |
| 2020 November | 56 | 33 | 89 |
| 2020 October | 53 | 21 | 74 |
| 2020 September | 55 | 16 | 71 |
| 2020 August | 74 | 26 | 100 |
| 2020 July | 51 | 18 | 69 |
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| 2020 May | 44 | 28 | 72 |
| 2020 April | 38 | 19 | 57 |
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| 2020 February | 5 | 2 | 7 |
| 2020 January | 4 | 9 | 13 |
| 2019 December | 4 | 7 | 11 |
| 2019 November | 4 | 2 | 6 |
| 2019 October | 0 | 6 | 6 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 4 | 3 | 7 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 6 | 10 |
| 2019 May | 5 | 16 | 21 |
| 2019 April | 2 | 19 | 21 |
| 2019 March | 2 | 17 | 19 |
| 2019 February | 0 | 10 | 10 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 4 | 8 | 12 |
| 2018 October | 2 | 12 | 14 |
| 2018 September | 2 | 4 | 6 |
| 2018 August | 0 | 11 | 11 |
| 2018 July | 0 | 14 | 14 |
| 2018 June | 0 | 14 | 14 |
| 2018 May | 0 | 8 | 8 |
| 2018 April | 0 | 4 | 4 |
| 2018 March | 25 | 6 | 31 |
| 2018 February | 91 | 14 | 105 |
| 2018 January | 100 | 10 | 110 |
| 2017 December | 85 | 16 | 101 |
| 2017 November | 84 | 12 | 96 |
| 2017 October | 87 | 15 | 102 |
| 2017 September | 64 | 8 | 72 |
| 2017 August | 97 | 19 | 116 |
| 2017 July | 73 | 20 | 93 |
| 2017 June | 76 | 30 | 106 |
| 2017 May | 61 | 30 | 91 |
| 2017 April | 65 | 15 | 80 |
| 2017 March | 63 | 31 | 94 |
| 2017 February | 154 | 13 | 167 |
| 2017 January | 69 | 17 | 86 |
| 2016 December | 123 | 11 | 134 |
| 2016 November | 164 | 7 | 171 |
| 2016 October | 149 | 13 | 162 |
| 2016 September | 249 | 15 | 264 |
| 2016 August | 204 | 11 | 215 |
| 2016 July | 119 | 14 | 133 |
| 2016 June | 20 | 12 | 32 |
| 2016 May | 14 | 16 | 30 |
| 2016 April | 11 | 6 | 17 |
| 2016 March | 17 | 6 | 23 |
| 2016 February | 18 | 3 | 21 |
| 2016 January | 23 | 3 | 26 |
| 2015 December | 17 | 1 | 18 |
| 2015 November | 32 | 2 | 34 |
| 2015 October | 35 | 9 | 44 |
| 2015 September | 19 | 3 | 22 |
| 2015 August | 33 | 4 | 37 |
| 2015 July | 234 | 21 | 255 |
| 2015 June | 171 | 15 | 186 |
| 2015 May | 179 | 23 | 202 |
| 2015 April | 174 | 20 | 194 |
| 2015 March | 191 | 16 | 207 |
| 2015 February | 194 | 16 | 210 |
| 2015 January | 187 | 18 | 205 |
| 2014 December | 183 | 21 | 204 |
| 2014 November | 174 | 23 | 197 |
| 2014 October | 307 | 41 | 348 |
| 2014 September | 379 | 29 | 408 |
| 2014 August | 723 | 31 | 754 |
| 2014 July | 652 | 42 | 694 |
| 2014 June | 755 | 38 | 793 |
| 2014 May | 746 | 40 | 786 |
| 2014 April | 758 | 32 | 790 |
| 2014 March | 665 | 19 | 684 |
| 2014 February | 701 | 28 | 729 |
| 2014 January | 1070 | 28 | 1098 |
| 2013 December | 1783 | 15 | 1798 |
| 2013 November | 691 | 21 | 712 |
| 2013 October | 571 | 10 | 581 |
| 2013 September | 539 | 14 | 553 |
| 2013 August | 296 | 16 | 312 |
| 2013 July | 18 | 25 | 43 |
| 2013 June | 15 | 32 | 47 |
| 2013 May | 18 | 22 | 40 |
| 2013 April | 20 | 24 | 44 |
| 2013 March | 33 | 17 | 50 |
| 2013 February | 188 | 15 | 203 |
| 2013 January | 828 | 9 | 837 |
| 2012 December | 323 | 7 | 330 |
| 2012 November | 1 | 2 | 3 |
| 2012 July | 1 | 0 | 1 |
Show all
