O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 19 Figure 2: Milky discharge aspirated from the vulva mass. Patient was extensively counselled and o ered excision of the masses as an alternative to stopping her breastfeeding. She declined the surgery and rather opted to stop breast feeding and replaced infant feeds with formula. She received a 5-day course of Carbegoline 1mg po daily to relief her symptoms and suppress lactation. is resulted in a signi cant reduction in the size of both the axillary and the vulva masses, to the patient’s satisfaction. (Figure 3) Figure 3: Clinical features a er suppressing lactation. (A) Right patient’s breast and axillary mass. (B) Shows signi cantly reduced vulva masses. Discussion e occurrence of ectopic breast tissue is rare, occurring with a frequency of 1-6% in females.1 It may occur anywhere along the milk line, which extends bilaterally from the axilla to the groin. During embryologic development of the breast at approximately four-week gestation, paired ectodermal thickenings produce the mammary ridges on the ventral surface of the embryo, which extends from the axillae to the medial thigh. Incomplete involution anywhere along the primitive milk streak is believed to lead to ectopic remnants of breast tissue.3,4 Clinically, vulvar breast tissue may present with vulvar swelling or as a vulvar “mass.” Lactating breast tissue in vulva develops mostly in later gestation and o en persists a er period of lactation. Ultimately, to achieve a de nitive diagnosis, a biopsy with histopathology con rmation is required.1 We describe a case of multicentric ectopic breast tissue with a lactating vulvar component. Ectopic breast is any type of breast tissue found outside the two normally situated pectoral breasts. Development of extra ectopic breast tissue results due to failure of the milk line ridges to involute, which run the length of the ventral body wall from the axillae to the groin in a curvilinear pattern.5 Ectopic breast of the vulva is an extremely rare condition that was rst described by Hartrung in 1872 with only a handful of cases reported since that time, including benign and malignant cases.6 Vulva ectopic breast usually takes the form of breast glandular tissue only. Fully developed breast with nipple and areola are very rare, and in other cases, when ectopic breast tissue in the vulva is primarily composed of adipose, it can be mistaken for a lipoma.1,3 Bell was the rst to reported lactating breast tissue on the vulva in 1926.7 e ectopic breast is hormonally responsive and is also subject to physiologic and pathologic changes.5 erefore, most cases are noted during pregnancy or lactation, as noted with our patient where ectopic breast masses were noticed and enlarged during pregnancy and lactation. e di erential diagnosis includes benign lesions like phylloides tumour, brocystic disease, sclerosing adenosis, epidermal cyst, follicular cyst, Bartholin’s cyst, intraductal papilloma, apocrine adenoma, syringoma and malignant lesions like Pagets disease or ductal or mucinous carcinoma.8,9 e commonest reported histological nding are normal breast tissues/benign lesions. e most frequent diseases reported in the ectopic breast are cancers followed by, mastopathy, mastitis, broadenoma and brocystic changes.10 Due to the rarity of the ectopic vulva breast and rarer, the concomitant occurrence of the bilateral axilla lesions, there are no clear guidelines or strong evidence to suggest the most e ective method of managing this condition. ere are authors who argue that since ectopic vulvar breast tissue serves no function but rather creates potential for disease (benign and malignant), it should be surgically excised immediately with clear margins. Nagnath et al reported that only 38 cases of ectopic breast tissue on vulva are documented in the world literature, out of which 10 were unilateral 1,5. ere is no guidance regarding follow up and perhaps screening for breast malignancy on the vulva in these patients. Medical management o er temporal symptom relief and reduce tumour size. Asymptomatic lesions probably do not require further treatment, but lesions may enlarge and cause discomfort. 11 Conclusion e positive e ect gained from milk suppression raises questions of prolonged use of breast suppressing drugs in those patients who decline surgery or are un t for surgery. A B O&G Forum 2022; 32: 18-20 CASE REPORT