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15 May 2013 - Case of the Week #273
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Thanks to Dr. Lamiaa Rouas, Mohamed V University School of Medicine (Morocco), for contributing this case and the discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
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Case of the Week #273
A 42 year old pregnant woman (first pregnancy) presented at 30 weeks gestation with an ulcerated nodule on the right labia minor. The lesion had been present for more than a year, but was exaggerated during pregnancy.
Physical examination showed a 2 cm mobile polyp with an ulcerated surface on the right labia minor, but was otherwise normal. There were no palpable breast masses, axillary or cervical lymphadenopathy. The polyp was biopsied.
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What is your diagnosis?
Ectopic mammary tissue of the vulva
The biopsy revealed an ulcerated polyp. Within its core are mammary-like ducts with a fibroadenomatous appearance. The tubules are lined by low columnar epithelium with uniform nuclei surrounded by a myoepithelial layer. The stroma is myxoid, with loose connective tissue and scattered inflammatory cells. The polyp surface had granulation tissue and acute inflammatory cells. There was no evidence of malignancy. Immunohistochemical testing was not done.
Ectopic mammary tissue occurs along the primitive milk line, from the axilla to groin (Vulva-ectopic mammary tissue at PathologyOutlines.com). It is considered by some to be a normal constituent of the anogenital area, which undergoes the same pathologic processes as in the breast (Adv Anat Pathol 2011;18:1). Excision is recommended to prevent development of these benign or malignant processes (Obstet Gynecol 2011;118:478)
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com