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2</a>&#41;&#46; A Montgomery gland&#44; with inflammatory changes and no drainable material&#44; was identified in the left areola&#44; medial to the nipple&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">What is your Diagnosis&#63;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0015" class="elsevierStylePara elsevierViewall">Montgomery or retroareolar cyst&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical Course and Treatment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical picture resolved after treatment with betamethasone &#40;0&#46;5 mg&#47;g&#41; and topical gentamicin &#40;1 mg&#47;g&#41; for 10 days&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Comment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Montgomery cyst is a rare entity in female adolescents and is even less frequent in males&#46; Its true incidence is unknown&#44; and the published literature is scant&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The cyst forms due to obstruction and dilation of the Montgomery tubercle&#44; a sebaceous gland closely connected to the terminal portion of the lactiferous duct&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Several hypotheses have been proposed to explain the mechanism by which these ducts are obstructed and dilated&#46; These include ineffective absorption of secretions&#44; squamous metaplasia of the duct surface&#44; primary autoimmune dilation of the duct&#44; and hormonally induced relaxation of the areolar muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical presentation can be symptomatic or asymptomatic&#46; The symptomatic form is more common&#44; presenting as an inflammatory retroareolar mass with pain and erythema&#46; It can be unilateral or bilateral &#40;up to 50&#37; of cases&#41;&#44; and is occasionally associated with a serous&#44; milky&#44; or brownish discharge from the nipple&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Breast ultrasound is the technique of choice both for diagnosis and follow-up&#46; In some cases&#44; typically those involving inflammation&#44; the cyst may present levels or septa and increased peripheral vascularity&#44; which is observed using the Doppler technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It is important to include retroareolar abscess in the differential diagnosis of Montgomery cyst&#46; Abscesses tend to be more fluctuating or indurated&#44; and are more likely to be accompanied by systemic symptoms&#46; Resolution of abscesses requires draining&#44; whereas Montgomery cysts have a benign course&#44; and respond well to antibiotic and anti-inflammatory treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a> Nonetheless&#44; it should be noted that retroareolar cysts can evolve to abscesses&#44; although this is rare&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Another condition included in the differential diagnosis is lymphangioma&#44; owing to the bluish appearance of the retroareolar mass&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment usually consists of outpatient oral antibiotic therapy with amoxicillin&#8211;clavulanic acid&#44; and nonsteroidal anti-inflammatories in cases of inflamed cysts&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Because the cysts respond well to the appropriate treatment&#44; incision and drainage are not recommended&#46; Drainage should be reserved for cysts that do not respond to treatment and evolve to abscesses&#44; or those in which ultrasound findings suggest malignancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;4</span></a> Symptomatic retroareolar cysts should be followed up 7 days after starting treatment to confirm resolution or a reduction in size&#46; Asymptomatic cysts usually resolve spontaneously&#44; although ultrasound follow-up is also recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Cases for Diagnosis
Breast Mass in an Adolescent Boy
Tumoración mamaria en un adolescente
A. Morelló Vicentea,
Autor para correspondencia
amorellovic@unav.es

Corresponding author.
, A. Elizalde Pérezb, A. Españaa
a Departamento de Dermatología, Clínica Universidad de Navarra, Spain
b Departamento de Radiología, Clínica Universidad de Navarra, Spain
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2</a>&#41;&#46; A Montgomery gland&#44; with inflammatory changes and no drainable material&#44; was identified in the left areola&#44; medial to the nipple&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">What is your Diagnosis&#63;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Diagnosis</span><p id="par0015" class="elsevierStylePara elsevierViewall">Montgomery or retroareolar cyst&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical Course and Treatment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical picture resolved after treatment with betamethasone &#40;0&#46;5 mg&#47;g&#41; and topical gentamicin &#40;1 mg&#47;g&#41; for 10 days&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Comment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Montgomery cyst is a rare entity in female adolescents and is even less frequent in males&#46; Its true incidence is unknown&#44; and the published literature is scant&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The cyst forms due to obstruction and dilation of the Montgomery tubercle&#44; a sebaceous gland closely connected to the terminal portion of the lactiferous duct&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Several hypotheses have been proposed to explain the mechanism by which these ducts are obstructed and dilated&#46; These include ineffective absorption of secretions&#44; squamous metaplasia of the duct surface&#44; primary autoimmune dilation of the duct&#44; and hormonally induced relaxation of the areolar muscle&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical presentation can be symptomatic or asymptomatic&#46; The symptomatic form is more common&#44; presenting as an inflammatory retroareolar mass with pain and erythema&#46; It can be unilateral or bilateral &#40;up to 50&#37; of cases&#41;&#44; and is occasionally associated with a serous&#44; milky&#44; or brownish discharge from the nipple&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Breast ultrasound is the technique of choice both for diagnosis and follow-up&#46; In some cases&#44; typically those involving inflammation&#44; the cyst may present levels or septa and increased peripheral vascularity&#44; which is observed using the Doppler technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It is important to include retroareolar abscess in the differential diagnosis of Montgomery cyst&#46; Abscesses tend to be more fluctuating or indurated&#44; and are more likely to be accompanied by systemic symptoms&#46; Resolution of abscesses requires draining&#44; whereas Montgomery cysts have a benign course&#44; and respond well to antibiotic and anti-inflammatory treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a> Nonetheless&#44; it should be noted that retroareolar cysts can evolve to abscesses&#44; although this is rare&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Another condition included in the differential diagnosis is lymphangioma&#44; owing to the bluish appearance of the retroareolar mass&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment usually consists of outpatient oral antibiotic therapy with amoxicillin&#8211;clavulanic acid&#44; and nonsteroidal anti-inflammatories in cases of inflamed cysts&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Because the cysts respond well to the appropriate treatment&#44; incision and drainage are not recommended&#46; Drainage should be reserved for cysts that do not respond to treatment and evolve to abscesses&#44; or those in which ultrasound findings suggest malignancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;4</span></a> Symptomatic retroareolar cysts should be followed up 7 days after starting treatment to confirm resolution or a reduction in size&#46; Asymptomatic cysts usually resolve spontaneously&#44; although ultrasound follow-up is also recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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