Rare disease

CASE REPORT

Fibroadenoma in axilla: another manifestation

of ectopic breast
Satyendra K Tiwary, Puneet Kumar, Ajay Kumar Khanna
Department of General SUMMARY
Surgery, Institute of Medical Fibroadenoma of an accessory breast is a rare disease.
Sciences, Banaras Hindu
University, Varanasi, Uttar The clinical significance lies in the fact that a number of
Pradesh, India cystic, inflammatory, neoplastic diseases similar to those
of a normal breast have been reported in accessory
Correspondence to breasts as well. Vigilant self-assessment and complete
Professor Ajay Kumar Khanna,
clinical examination are always encouraged to detect
[email protected]
earliest malignancy in the axilla. We report two cases of
Accepted 1 April 2015 ectopic breast fibroadenoma with the relevant literature.

BACKGROUND
Ectopic breast tissue can occur anywhere along the
milk line, from the axilla to the groin. Fibroadenoma
of an ectopic breast is a rare disease. The clinical sig- Figure 1 Clinical photograph of fibroadenoma of
nificance lies in the fact that a number of cystic, accessory breast in axilla.
inflammatory, neoplastic diseases similar to that of a
normal breast have also been reported in accessory as in male patients.3 Ectopic breast tissues have
breasts. We report two cases of ectopic breast fibro- been reported even on the face, perineum and
adenoma with the relevant literature. vulva.4 The clinical significance lies in the fact that
a number of cystic, inflammatory, neoplastic dis-
eases similar to those of a normal breast have been
CASE PRESENTATION reported. Ectopic breasts also indicate presence of
An 18-year-old noticed left axillary swelling of
an underlying genitourinary and cardiovascular
3-month duration. On examination, a 3 cm×2 cm
system abnormality.4 5 Fibroadenoma is a common
subcutaneous lump with well-defined margins and
cause of breast mass in young women, with highest
firm in consistency with marked mobility was incidence between the ages of 20 and 30 years. It is
noticed in the axilla (figure 1). Fine-needle aspir- rarely described in axillary supernumerary breasts.6
ation cytology (FNAC) revealed it to be a fibro- The breast tissue develops from the embryonic
adenoma. Surgical exploration (figure 2) was ectodermal thickenings extending from the axilla to
carried out through axillary incision. The histo- the groin region. During development, the breast
pathology of an excised specimen (figure 3) con- tissue develops in the pectoral region and the rest
firmed a fibroadenoma. Our second case had a of the milk line (also called Hugh line) undergoes
similar clinical picture: a 21-year-old woman pre- regression. Supernumerary breasts develop either as
sented with right axillary swelling and was diag- a result of failure of regression and milk line dis-
nosed as having a fibroadenoma, as revealed by placement7 or from the modified apocrine sweat
FNAC and histopathology after excision biopsy. glands.8 Uncommon locations, also known as
We have presented two cases of fibroadenoma of ‘mammae erraticae’, include the buttocks, back of
an accessory breast in axilla. Both were young neck, face, flank, upper arm, hip, shoulders and
women with cosmetic concerns about asymptom-
atic axillary masses. Both underwent excision
biopsy and histopathology revealed fibroadenoma
of ectopic breast. They had no coexistent urinary
or cardiac disease. They are presently asymptom-
atic. This case report underscores the need to con-
sider an accessory breast mass as a possible
differential diagnosis for lumps along the milk line,
and the need for careful work up and treatment, as
there is a risk of malignant transformation.

To cite: Tiwary SK,

Kumar P, Khanna AK. BMJ
DISCUSSION
Case Rep Published online: The incidence of ectopic breast is 1–6% in the
[please include Day Month general population.1 The axillary breast tissue is a
Year] doi:10.1136/bcr-2015- subtype of ectopic breast occurring in 2–5% of
209535 women.2 It is twice as common in female patients Figure 2 Surgical exposure of fibroadenoma in axilla.
Tiwary SK, et al. BMJ Case Rep 2015. doi:10.1136/bcr-2015-209535 1
 Rare disease

examined, supplemented with supraclavicular fossae and latero-

cervial lymph nodes examination, as one should never miss
even a single doubtful case of malignancy in axillary masses. In
cases of bilateral axillary ectopic breast tissue, work up should
be similar to that of unilateral mass.16 The diagnostic (mam-
mography, ultrasonography, cytology and biopsy) and thera-
peutic protocol for a supernumerary breast mass is similar to
that of a normal breast mass.6 The diagnosis is usually delayed
because of lack of suspicion of this rare condition.
The presence of an extra breast or nipple also raises the suspi-
cion of an underlying urinary tract abnormality requiring evalu-
ation. Finally, the investigative and therapeutic modalities remain
the same with malignant diseases requiring wide local excision.

Learning points

▸ Accessory breasts are likely to develop inflammatory and

malignant changes similar to normal breasts.
▸ Fibroadenoma of accessory breast in axilla is a very rare
possibility but may present in young women.
▸ Vigilant self-examination of accessory breasts similar to that of
normal breasts is encouraged, for earliest detection of lesions.
▸ Complete clinical examination of swellings of accessory
breasts supplemented with fine-needle aspiration cytology is
the basic tool for management.
▸ Follow-up after excision biopsy of fibroadenomas in axillae is
essential to detect at the earliest any further pathological
changes.

Contributors SKT, PK and AKK drafted the manuscript, collected data, critically
Figure 3 Excised fibroadenoma. reviewed and finally drafted the manuscript.
Competing interests None declared.
midline of the back and chest.9 The tissue rest usually increases Patient consent Obtained.
in size during puberty, pregnancy and puerperium.9
Provenance and peer review Not commissioned; externally peer reviewed.
Supernumerary breasts are classified as follows:10 type 1: com-
plete breast with areola and nipple; type II: supernumerary REFERENCES
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2 Tiwary SK, et al. BMJ Case Rep 2015. doi:10.1136/bcr-2015-209535

 Rare disease

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Tiwary SK, et al. BMJ Case Rep 2015. doi:10.1136/bcr-2015-209535 3