A Study of Evaluation and Management of Rare Congenital Breast Diseases

Abstract

Introduction: Polymastia and polythelia may be asymptomatic or cause pain, restriction of arm movement, milk discharge, cosmetic problems or anxiety. Cosmesis is the main indication for surgical excision of accessory breasts in axilla. In addition it also confirms the diagnosis and allays the patient's fear of harbouring a malignancy.

Aim: To evaluate the presentation of symptoms, investigations required for diagnosis and the management to improve the treatment protocols in patients with breast diseases.

Materials and methods: This retrospective study on breast diseases presenting as supernumerary breasts and nipples was conducted in the Department of Surgery between January 2013 and January 2016 at MMIMS Research and hospital, Mullana, Ambala. Patients were evaluated for breast diseases, either benign or malignant in both genders. A total of 32 cases diagnosed as accessory breasts disease were retrieved from the hospital archive. The clinical and radiological evaluation was done in the form of ultrasound and mammography wherever necessary. Accessory breast tissues were excised under general anesthesia and histopathological examinations were done.

Results: Out of 32 cases: 1(3.125%) male patient had unilateral and 1(3.125%) male had bilateral accessory nipple, 7 (21.87%) females had unilateral and 1(3.125%) had bilateral accessory nipple, 1 (3.125%) diagnosed as accessory axillary fibroadenoma in female, 16(50%) presented as unilateral and 5 (15.62%) had bilateral swelling in the axilla as accessory breast. Patients underwent surgical excision and in 8(25%) cases z- shaped incision was made in view of better cosmesis. Patients were followed up upto 6 months postoperatively. There were no residual swelling and movements of the arm over the shoulder joint were normal. In 3(9.37%) cases, wound dehiscence occurred; in 2 (6.25%) cases lymphoedema formation was seen. These were successfully managed conservatively.

Conclusion: As breast swellings either fibroadenoma or carcinoma are common entities to come across everywhere but accessory breasts are rarely encountered especially in rural areas because of less awareness. The study found that there was tendency to neglect the swelling as there were minimal symptoms present. We also came across a rare entity, accessory breast and accessory nipples. A clinician should not ignore such cases taking as simple swelling because of chances of discovering a malignancy can occur.

Keywords: Accessory breast; Axilla; Lymph node; Malignancy; Milk line; Nipple.

[Table/Fig-3a-g]:

Gross appearance of the unilateral and bilateral accessory nipples in inframammary and subcoastal area; d) Another gross picture revealed enlargement of the right breast with accessory nipple (marked with arrow); e) Showing bilateral nipples in female; f) Showing in male patient; g) Showing unilateral accessory nipple in male patient (marked with arrow).

[Table/Fig-4]:

Gross picture revealed bilateral and unilateral axillary accessory breast.

[Table/Fig-5a-d]:

a) Swelling held in between the fingers on the left side of axilla; b) Gross appearance of the normal breast and dissected area of axilla showing swelling alongwith accessory tissue; c) Operative section revealed fibroadenoma held with the Allis forceps; d) Gross resected specimen.

[Table/Fig-6]:

On ultrasonography, there is evidence of the normal fibrofatty and fibrogladular tissue in axilla suggestive of accessory breast.

[Table/Fig-7a-f]:

a) Showed z shaped incision and postoperative healed scar mark in axilla; b) Gross appearance of the bilateral healed scar mark in axilla; c&d) an elliptical incision showing yellowish white in colour tissue held in Allis forcep; e) Operative picture showing accessory tissue and gross appearance of the specimen; f) Skin closed with staples and drain in situ.

[Table/Fig-8a-c]:

a) fine needle cytology showed fibromyxoid stroma and bare nuclei confirmed as accessory breast fibroadenoma (MGG; X- 100); b&c) histopathology showed a well defined tumour composed of ductular and stromal proliferation. The ducts are lined by a bilayered epithelial and myoepithelial layer (H & E x 100).

[Table/Fig-9a-d]:

On histopathology – a - section shows mammary duct and lobules embedded in fibrocollagenous adipose tissue stroma {a) H & E 40 X; b&c) on 100 x zoom}; d) shows benign breast tissue surrounded by fibrocollagenous stroma and mammary duct (H & E 40 X).

[Table/Fig-10a-d]:

On histopathology a) section shows fibroadipose tissue along with focal area reveal benign breast lobules and ducts (H & E 40 x zoom); b & c) section reveal benign breast tissue along with dilated blood vessel (H & E 40 x zoom); d) Showing normal breast parenchyma in form of ducts, fibrotic stroma and adipose tissue. The ducts are lined by bilayered epithelial and myoepithelial layer (H & E x 40).