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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. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto. 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 (G1P0) presented at 30 weeks gestation with an ulcerated nodule on the right labium minus. 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 labium minus, 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?
Mammary-type fibroadenoma of the vulva
The biopsy revealed appearance polypoid lesion with distinct epithelial and mesenchymal components. The epithelium is organized in ductal elements lined by low columnar uniform epithelium surrounded by a myoepithelial layer. The stromal component 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. The findings are in keeping with a fibroadenoma, identical to those seen in the breast.
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). Epithelial and fibroepithelial lesions seen in the native breast can also originate in ectopic mammary tissue, such as in this case. Excision is recommended to confirm the diagnosis and provide symptomatic relief (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