Accessory Mammary Tissue Research Articles

Nipple adenoma arising in a supernumerary mammary gland: a case report.

Nipple adenoma, a benign tumour of the breast, is a relatively rare occurrence. This report describes an even rarer case of nipple adenoma arising within a supernumerary mammary gland. The presenting symptoms were a lump and throbbing pain in the axilla. Ultrasound scan and core biopsy proved inconclusive so surgical excision was undertaken, thus allowing a histological diagnosis. The patient made a full and uneventful recovery. Physicians must be aware that diseases of the breast and nipple-areola complex may also arise in accessory mammary tissue and accessory nipples should not be discounted as a common congenital anomaly. Instead they must be regarded, examined and treated as normal breast tissue.

Incidental Discovery of Supernumerary Breast Tissue in Dissection Course: Case Report and Review of Literature

Accessory mammary tissue is rare in the clinical practice, and may be present as polythelia or polymastia. Polythelia (one or more supernumerary nipples) is a congenital condition, being detectable during childhood. Polymastia (more than two mammary glands) may not be evident until puberty. During the seventh gestational week, the embryologic mammary line (“milk line”) is represented by two thickened strips of ectoderm, which extend from the axilla to the inguinal region, and only a small portion of this line might persist. In case it doesn't disappear, an accessory breast may develop anywhere along the streak. The objective of this work is to report the finding of accessory breasts in the lower thoracic wall of a body belonging to the Body Donation Program at UFCSPA. The body in question was female, Caucasian, 84 years old, with no history of breast cancer. During dissection, two accessory breasts were identified in the lower thoracic wall, below the chest muscles, equidistant from each other, the right one measuring 3,0 × 2,7cm, and the left measuring 2,5 × 2,5cm. Samples for histological analysis were extracted and using hematoxylin and eosin staining. Breast tissue was identified, confirming the hypothesis of polymastia. Accessory breast tissue is an uncommon finding in women (2–6%) as well as in men (1–3%). Usually it develops along the course of the embryologic mammary line, and may be solitary or multiple, arising on one or both sides of the line. They are usually asymptomatic, not demanding medical intervention. However, in cases of development in females, the surgical resection of the accessory breast may be necessary, once there is greater symptomatology due to the influence of hormonal variations. There are reports of neoplasic proliferation in this tissue (0,3%). Therefore, this finding becomes important in the medical practice, since it should be remembered as a possible source of malignant neoplasm, and in the differential diagnosis of other soft‐tissue tumors.

Polythelia and associated hydronephrosis: a case report in neonatal age

Abstract Polythelia, the presence of supernumerary nipples, is a common anomaly usually limited to cosmetic concerns. However, the existence of accessory mammary tissue may indicate associated anomalies of the kidneys and the urinary tract or other systemic diseases. The association of these anomalies and systemic disease is often controversial, although some authors report their significance in neonates and infants. We report the association of accessory nipple and right-sided hydronephrosis in a female term newborn. Prenatal ultrasound monitoring did not indicate hydronephrosis and it was diagnosed after birth with an ultrasound examination of the newborn, which was due to a fever and suspected urinary infection. We consider that in symptomatic infants with accessory breast tissue, a thorough physical examination, urine analysis, and renal ultrasound should be done in order to exclude associated urinary tract abnormalities.

Anomalous single coronary artery accompanied by accessory mammary tissue presenting with typical angina pectoris

Abstract Single coronary artery is described as an isolated coronary artery originating from the aortic root through a single ostium in the absence of another ostium. The single coronary artery is the only source for blood supply to the whole heart. In this case we present a patient admitted to the outpatient clinic with typical chest pain, whose physical examination indicated accessory mammary tissue without any additional physical examination findings. The patient had hyperlipidemia and hypertension risk factors, and a coronary angiography was planned. The coronary angiography performed on the 72 year old male patient revealed a single coronary artery. According to the angiography, it is reported that the whole coronary system is distributed to the heart from a single trunk originating from the right sinus of valsalva. The multislice computerized tomography showed that the left anterior descending, circumflex and right coronary arteries originated from single trunk at the level of right sinus of valsalva through a single ostium without the left main trunk. There was no additional congenital anomaly. The patient, who had noncritical strictures, was discharged with medical treatment. Neural crest cells, matrix metalloproteinase, epidermal growth factor receptors, vascular endothelial growth factor and receptors are effective in the development of coronary arteries and mammary tissues in the embryonic phase. Any impact on the migration routes of the neural crest cells or distortion of the synthesis of expression products may have caused this kind of an anomaly. Keywords: Coronary artery anomaly, accessory mammary tissue, embryogenesis Ozet Tek koroner arter, aort kokunden tek koroner ostiyum araciligiyla cikan ve ikinci bir ostiyumun gozlenmedigi izole koroner arter olarak tanimlanir. Tek koroner arter butun kalbin kan akiminin saglanmasindan sorumludur. Bu olguda, tipik gogus agrisi nedeniyle poliklinige basvuran, fizik muayenesinde aksesuar meme dokusu olan ve ek fizik muayene bulgusu olmayan bir hasta sunuldu. Hiperlipidemi ve hipertansiyon risk faktorleri olan hastaya koroner anjiyografi planlandi. Yapilan koroner anjiyografide tek koroner arter saptanan 72 yasinda erkek hasta sunuldu. Koroner anjiyografide tum koroner sistemin sag sinus valsalva’dan cikan tek govdeden kalp bolgesine yayilim gosterdigi saptandi. Cokkesitli bilgisayarli tomografide, sol on inen, sirkumfleks ve sag koroner arterlerin sol ana govde olmaksizin tek ostiyum araciligi ile sag sinus Valsalva duzeyinde tek govdeden koken aldiklari izlendi. Ek konjenital anomali izlenmedi. Nonkritik darliklari olan hasta medikal tedavi ile taburcu edildi. Koroner arter ve meme dokusunun embriyonal donemde gelismesinde, noral krista hucreleri, matriks metalloproteinazlar, epidermal buyume faktor reseptorleri, vaskuler endotelyal buyume faktoru ve reseptorleri etkilidir. Noral krista hucrelerinin goc yollarinin etkilenmesi ya da ekspresyon urunlerinin sentezlenmesindeki bir aksaklik bu tur bir anomali olusmasina yol acmis olabilir. Anahtar sozcukler: Koroner arter anomalisi, aksesuar meme dokusu, embriyogenez

Primary ectopic breast carcinoma in a supernumerary breast arising in the anterior chest wall: a case report and review of the literature

Accessory mammary tissue occurs in 0.2–6% of women, and is under the same hormonal influences as breast tissue, potentially undergoing malignant transformation. Carcinomas of accessory mammary tissue account for ∼0.3% of breast cancers, 5% of which are within a supernumerary breast. Due to its rarity and the low index of clinical suspicion, it is often diagnosed at a later stage compared with breast cancer. Reports of carcinoma developing in a supernumerary breast are rare. We describe a case of a 48-year-old woman, presenting with ectopic breast carcinoma within a supernumerary breast below the inframammary fold. We describe the mode of presentation, diagnosis and treatment with reference to the available literature. The radiotherapy treatment plan is discussed in detail to provide reference for future cases as the available literature offers no formal guidance on radiotherapy dose, fractionation or treatment field.

Nipple Adenoma Arising in a Supernumerary Mammary Gland: A Case Report

Nipple adenoma, a benign tumour of the breast, is a relatively rare occurrence. This report describes an even rarer case of nipple adenoma arising within a supernumerary mammary gland. The presenting symptoms were a lump and throbbing pain in the axilla. Ultrasound scan and core biopsy proved inconclusive so surgical excision was undertaken, thus allowing a histological diagnosis. The patient made a full and uneventful recovery. Physicians must be aware that diseases of the breast and nipple-areola complex may also arise in accessory mammary tissue and accessory nipples should not be discounted as a common congenital anomaly. Instead they must be regarded, examined and treated as normal breast tissue.

Paget’s disease of the axilla arising from an underlying accessory mammary tissue

Paget’s disease of the axilla arising from an underlying accessory mammary tissue

Polythelia: Still a marker of urinary tract anomalies in children?

Supernumerary nipples (SNN), or polythelia, are the most common form of the accessory mammary tissue malformation. The frequency of this condition ranges from 0.2% to 5.6% depending on various factors. This condition is associated with several anomalies, although this association is often controversial. The aim of this study was to evaluate the association between SNN and kidney/urinary tract (K/UT) anomalies, where anomalies is taken to mean functional disorders, malformations and diseases. A case-control study was performed. The study evaluated 166 children (case group) referred to the Pediatric Nephrology Unit of the Department of Pediatrics of the Catholic University of Rome and 182 children (control group) admitted to the Department of Pediatrics because of pathologies not involving the urinary tract. There were 11 children with SNN in the case group, and only two patients in the control group (6.62% vs 1.09%, p<0.05). The results show a high incidence of K/UT anomalies in children with SNN, and therefore K/UT should be investigated in this specific population.

An uncommon location for accessory breast tissue: inner thigh

Sir: Polymastia or accessory breast tissue has been described in humans for centuries. Ectopic breast tissue can occur anywhere along the bilateral primitive embryonic milk line, extending from the axilla to the groin [3]. Its reported incidence varies between 0.4–6 %, so it is an infrequent clinical finding [1]. Accessory mammary tissue has been repeatedly reported to occur in axilla, chest, abdominal wall, and vulva. A 64-year-old female patient presented with a lump in the inner aspect of her right thigh present for at least 10 years. The only complaint was the friction that the lump caused while walking. Physical examination revealed a skin colored dermal nodule 2 cm in diameter with a papillomatous appearance centrally (Figs. 1 and 2). An underlying 5cm subcutaneous firm mobile nontender mass beneath this nodule was present in the medial side of her right thigh at the junction of the upper one third and lower two thirds of the thigh (Figs. 1 and 3). Medical history was unremarkable except for hypertension. The authors diagnosed this as an accessory nipple associated with glandular tissue. The condition was explained to the patient but she refused any imaging modalities and did not accept surgical treatment. In the 5-week-old human embryo, it is reported that ectodermal streak develops on the ventral surface of the embryonic trunk and extends from the axilla to the groin bilaterally [1, 3]. Most of this milk line disappears soon after its formation but persists bilaterally only in the thoracic region to form future breasts [1, 3]. On occasion, residual fragments may persist and give rise to accessory breast tissue along the original distribution of the milk line in other regions [1, 3, 5]. Less commonly, accessory breast tissue has also been reported to occur in locations outside the milk line: face, posterior neck, chest, mid-back, buttock, vulva, flank, hip, posterior and/or lateral thigh, shoulder, and upper extremities [4, 5]. The incidence of each anatomic location varies [5]. The authors concluded that there were two other reported cases with accessory breast tissue present in the inner thigh after reviewing the drawing that Patten used in his book printed in 1946 [4]. The accessory breast tissue may take several forms [3]. This patient possibly has a supernumerary breast with a nipple associated with glandular tissue located in the medial side of her right thigh. Alghamdi et al. reported surgical excision percentage for accessory breast tissue to be 28% in their studies. The other Eur J Plast Surg (2008) 31:339–340 DOI 10.1007/s00238-008-0286-3

Pigmented Axillary Nodule: Carcinoma of an Ectopic Axillary Breast

Ectopic mammary tissue appears in humans owing to an incomplete embryologic regression of the mammary ridges. The same pathology that affects normally positioned breasts, including carcinoma, can occur in ectopic mammary tissue. The objective was to present the case of a 43-year-old woman who developed a ductal mammary carcinoma of ectopic breast tissue. We describe the patient's history, the histologic diagnosis, and the therapy carried out. We also discuss the clinical differential diagnosis and current management options. The patient developed a ductal mammary carcinoma in the axilla, which is the most common site for the occurrence of carcinoma of ectopic breast tissue. She has been sucessfully treated with surgery, lymphadenectomy, radiotherapy, and chemotherapy. Accessory mammary tissue is a relatively frequent incidental finding, whereas carcinoma of ectopic tissue is very rare. Carcinoma occurring in ectopic breast tissue remains rare, but this diagnosis must be suspected when confronted with any axillary nodule. The prognosis is similar to carcinoma of normal breast in the same tumor, node, metastasis stage, although it has a higher rate of lymph node involvement. There is no consensus on the advisability of excising ectopic mammary tissue.

Pigmented Axillary Nodule

BACKGROUND Ectopic mammary tissue appears in humans owing to an incomplete embryologic regression of the mammary ridges. The same pathology that affects normally positioned breasts, including carcinoma, can occur in ectopic mammary tissue. OBJECTIVE The objective was to present the case of a 43-year-old woman who developed a ductal mammary carcinoma of ectopic breast tissue. METHODS We describe the patient's history, the histologic diagnosis, and the therapy carried out. We also discuss the clinical differential diagnosis and current management options. RESULTS The patient developed a ductal mammary carcinoma in the axilla, which is the most common site for the occurrence of carcinoma of ectopic breast tissue. She has been sucessfully treated with surgery, lymphadenectomy, radiotherapy, and chemotherapy. Accessory mammary tissue is a relatively frequent incidental finding, whereas carcinoma of ectopic tissue is very rare. CONCLUSIONS Carcinoma occurring in ectopic breast tissue remains rare, but this diagnosis must be suspected when confronted with any axillary nodule. The prognosis is similar to carcinoma of normal breast in the same tumor, node, metastasis stage, although it has a higher rate of lymph node involvement. There is no consensus on the advisability of excising ectopic mammary tissue.

Lobular Carcinoma in Ectopic Axillary Breast Tissue

Accessory mammary tissue is reported to occur in 2 per cent to 6 per cent of women and results from failure of regression of a portion of the galactic band, which runs from the axilla to the groin during embryogenesis. The differential diagnosis of a mass located along the course of the primitive milk line must include accessory breast tissue. This tissue is subject to the same physiologic and pathologic changes as in the breast proper. There are numerous case reports of masses arising in accessory breast tissue ranging from fibroadenomas and phyllodes tumors to invasive mucinous adenocarcinoma. The predominant pathology, as with the pectoral breast, is that of invasive ductal carcinoma. We present the case of a lobular carcinoma arising in axillary ectopic breast tissue. Although this has previously been reported, it is a rare entity.

Polythelia pilosa: A Particular Form of Accessory Mammary Tissue

Background: The old Kajawa classification which considered eight possible forms of aberrant mammary tissue has been recently modified into a simpler one that considers this condition only when there is glandular parenchyma or when the aberrant tissue is not a glandular tissue but a nipple, an areola or both. This new classification disregards ‘polythelia pilosa’ defined as an ‘isolated patch of hairs only’. Objective: To demonstrate that polythelia pilosa is at least a marker of subjacent accessory mammary tissue and, consequently, that the term should be incorporated into the current classification. Methods: Among 72 cases of aberrant or accessory mammary tissue, we have studied 14 cases (7 men and 7 women) that were clinically diagnosed as ‘visible isolated patches of hairs, apparently without pigmentation nor structures of areola or nipple’. We excised such isolated patches in 3 women. Results: The histopathological examination showed an acanthotic and hyperpigmented epithelium with central depression closed by keratin plugs; in the dermis there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type could be observed. Conclusion: Since the biopsy of isolated patches of hairs demonstrated structures of either areolar or apocrine glandular tissue, we think that the term ‘polythelia pilosa’ should be reinstated into the classification as it is at least a marker of true aberrant mammary structures in men and hirsute women.

Book reviews

Book reviews in this article: Franz Heinrich Martens Principles and Techniques of Cutaneous Surgery Gary P. Lask and Ronald L. Moy Accessory Mammary Tissue in Ciinicai Practice Carlo Enrico Urbani and Roberto Betti Books received Nails: Therapy, Diagnosis, Surgery Richard K. Scher and Ralph Daniel, III Practical Dermatology, 2nd edn. Beth G. Goldstein and Adam O. Goldstein Eighty years of History ‐ Department of Dermatology ‐ Yonsei university College of Medicine Dongsik Bang

FC072 The spectrum of intra-areolar accessory mammary tissue

FC072 The spectrum of intra-areolar accessory mammary tissue

Book Review

Book Reviewed in this article Accessory Mammary Tissue in Clinical Practice. Carlo Enrico Urbani and Roberto Betti