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." 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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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| año/Mes | Html | Total | |
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| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 8 | 12 |
| 2018 Octubre | 2 | 12 | 14 |
| 2018 Septiembre | 2 | 4 | 6 |
| 2018 Agosto | 0 | 11 | 11 |
| 2018 Julio | 0 | 14 | 14 |
| 2018 Junio | 0 | 14 | 14 |
| 2018 Mayo | 0 | 8 | 8 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 25 | 6 | 31 |
| 2018 Febrero | 91 | 14 | 105 |
| 2018 Enero | 100 | 10 | 110 |
| 2017 Diciembre | 85 | 16 | 101 |
| 2017 Noviembre | 84 | 12 | 96 |
| 2017 Octubre | 87 | 15 | 102 |
| 2017 Septiembre | 64 | 8 | 72 |
| 2017 Agosto | 97 | 19 | 116 |
| 2017 Julio | 73 | 20 | 93 |
| 2017 Junio | 76 | 30 | 106 |
| 2017 Mayo | 61 | 30 | 91 |
| 2017 Abril | 65 | 15 | 80 |
| 2017 Marzo | 63 | 31 | 94 |
| 2017 Febrero | 154 | 13 | 167 |
| 2017 Enero | 69 | 17 | 86 |
| 2016 Diciembre | 123 | 11 | 134 |
| 2016 Noviembre | 164 | 7 | 171 |
| 2016 Octubre | 149 | 13 | 162 |
| 2016 Septiembre | 249 | 15 | 264 |
| 2016 Agosto | 204 | 11 | 215 |
| 2016 Julio | 119 | 14 | 133 |
| 2016 Junio | 20 | 12 | 32 |
| 2016 Mayo | 14 | 16 | 30 |
| 2016 Abril | 11 | 6 | 17 |
| 2016 Marzo | 17 | 6 | 23 |
| 2016 Febrero | 18 | 3 | 21 |
| 2016 Enero | 23 | 3 | 26 |
| 2015 Diciembre | 17 | 1 | 18 |
| 2015 Noviembre | 32 | 2 | 34 |
| 2015 Octubre | 35 | 9 | 44 |
| 2015 Septiembre | 19 | 3 | 22 |
| 2015 Agosto | 33 | 4 | 37 |
| 2015 Julio | 234 | 21 | 255 |
| 2015 Junio | 171 | 15 | 186 |
| 2015 Mayo | 179 | 23 | 202 |
| 2015 Abril | 174 | 20 | 194 |
| 2015 Marzo | 191 | 16 | 207 |
| 2015 Febrero | 194 | 16 | 210 |
| 2015 Enero | 187 | 18 | 205 |
| 2014 Diciembre | 183 | 21 | 204 |
| 2014 Noviembre | 174 | 23 | 197 |
| 2014 Octubre | 307 | 41 | 348 |
| 2014 Septiembre | 379 | 29 | 408 |
| 2014 Agosto | 723 | 31 | 754 |
| 2014 Julio | 652 | 42 | 694 |
| 2014 Junio | 755 | 38 | 793 |
| 2014 Mayo | 746 | 40 | 786 |
| 2014 Abril | 758 | 32 | 790 |
| 2014 Marzo | 665 | 19 | 684 |
| 2014 Febrero | 701 | 28 | 729 |
| 2014 Enero | 1070 | 28 | 1098 |
| 2013 Diciembre | 1783 | 15 | 1798 |
| 2013 Noviembre | 691 | 21 | 712 |
| 2013 Octubre | 571 | 10 | 581 |
| 2013 Septiembre | 539 | 14 | 553 |
| 2013 Agosto | 296 | 16 | 312 |
| 2013 Julio | 18 | 25 | 43 |
| 2013 Junio | 15 | 32 | 47 |
| 2013 Mayo | 18 | 22 | 40 |
| 2013 Abril | 20 | 24 | 44 |
| 2013 Marzo | 33 | 17 | 50 |
| 2013 Febrero | 188 | 15 | 203 |
| 2013 Enero | 828 | 9 | 837 |
| 2012 Diciembre | 323 | 7 | 330 |
| 2012 Noviembre | 1 | 2 | 3 |
| 2012 Julio | 1 | 0 | 1 |
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