Case Report
Supernumerary Nipple Presenting as a Vulvar Mass in an Adolescent: Case Report and Literature Review

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Abstract

Background

Ectopic breast tissues can be found along the embryonic mammary ridges and can occur in the vulva. While ectopic breast tissue is not uncommon, functional breast with overlying nipple located within the vulva is exceedingly rare.

Case

A 17-year-old with undiagnosed hypothyroidism presents with vulvar mass draining milky white fluid. A small lesion with appearance similar to a skin tag is noted and milky fluid expressed. Biopsy and excision of this mass confirmed the presence of a functional supernumerary nipple.

Summary and Conclusions

This appears to be the first reported case of a supernumerary nipple with symptomatic lactation in a non-pregnant adolescent. Supernumerary nipple should be considered in the differential diagnosis of a vulvar mass. Ectopic breast tissue in the vulva can undergo malignant transformation, therefore excision of this tissue is generally recommended.

Introduction

Lesions commonly cited when considering the vulvar mass in an adolescent include benign and malignant tumors, cysts, infections, inguinal hernia, embryonic remnants, and growth secondary to congenital adrenal hyperplasia or precocious puberty.1 Supernumerary nipple of the vulva is rarely mentioned in this differential, particularly in the adolescent population. We present a case of supernumerary nipple (SN) of the vulva diagnosed in a 17-year-old female.

Section snippets

Case Report

A 17-year-old Caucasian female was referred to pediatric and adolescent gynecology for management of a microperforate hymen discovered after she was unable to insert a tampon. Her menses began at age 14 and initially were irregular, then developing a regular pattern lasting 6–7 days. Incidentally a history of leakage from the vulvar area was revealed. At age 15 she developed marked swelling of the vulvar region accompanied by a large amount of white fluid draining from this region. Over the

Discussion

Although the differential diagnosis of a vulvar mass in an adolescent is extensive, the diagnosis can often be established through careful inspection and biopsy.2 Benign tumors are more commonly seen than malignant tumors in the adolescent and can arise from a variety of cell types including neural tissue in granular cell tumors and neurofibromatosis lesions, vascular tissue in hemangiomas, and the many possible mature cell lines seen in hamartomas.1 Other benign tumors include lymphangiomas,

Conclusions

We present the first reported case of a SN in the vulva with symptomatic lactation in a nonpregnant adolescent. We hypothesize that her undiagnosed hypothyroidism may have led to the stimulation of the breast tissue and subsequent lactation. SN is rare but should be considered in the differential of a vulvar mass in the adolescent. Diagnosis can be confirmed by history, clinical exam and biopsy. Ectopic breast tissue in the vulva, from both embryonic remnants or native MLG, is capable of

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