Axillary accessory breast tissue – case report and review of literature
Axillary accessory breast tissue – case report and review of literature
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腋窝副乳腺组织——病例报告及文献复习
DOI：
10.1111/ddg.12285
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
J. Hassel
中科院分区：
文献类型：
--
作者：
M. Kogut;M. Bidier;A. Enk;J. Hassel
多乳症是一种罕见的乳房疾病，影响大约2-6%的女性和1-3%的男性。三分之一的受影响个体有一个以上的副乳腺组织[1]。两名妇女到皮肤科门诊就诊，抱怨腋窝有肿块。第一位病人是一位25岁的女性，她发现右腋窝有一个肿块，限制了她的自由活动。她以为是淋巴结。临床检查发现一个柔软、可移动的4 × 4 cm结节。超音波检查发现一软组织肿块，但灌注并未增加。第2例患者为40岁女性，主诉间歇性双侧腋窝疼痛，首次发生于2009年双侧腋窝汗腺皮下刮除术后。患者注意到月经周期相关肿胀和不适。双侧腋窝可触及小的可移动皮下软组织肿块（图1）。超声检查提示结节与原位乳腺组织相似（图2）。临床鉴别诊断考虑包括脂肪瘤或淋巴结病。在第二例患者中，必须考虑术后变化，如脂肪组织坏死、异物肉芽肿或结缔组织纤维化。超音波检查导致疑似异位乳房组织的诊断。由于结节引起的不适，并确认诊断，我们建议在这两种情况下手术切除。第一组妇女的受影响组织被切除。第二例仅行深部切除活检以明确诊断。在组织学上，两名患者的标本均显示在部分纤维化结缔组织中存在多个排泄管和顶泌腺腺泡，为典型的乳腺组织结构（图3）。异位乳腺组织的诊断得到证实。副乳是一种胚胎期乳房嵴部分持续存在的畸形。胚胎乳线是在胚胎发育的第一个月由表皮增厚而产生的，在胚胎发育的第二个月开始时，表皮增厚而形成乳嵴。这些从腋窝到腹股沟两侧延伸。最初发育出许多腺体，除了一个位于胸中部的腺体外，所有腺体在胚胎的第三个月开始退化。剩余的腺体形成后乳腺的原基[2，3]。乳房嵴的其他部分的持续存在可能导致多乳头（副乳头）或多乳房（副乳腺）。多乳症可以发生为腺性（mamma aberrata）或完全性多乳症（mamma accessoria）[2]。腺性多乳症或副乳腺组织的特征是孤立的实质肿块，无乳头，通常位于乳房附近，但也可能位于腋窝、外阴、腹股沟或其他区域[2，4，5]。异位乳腺组织从出生就存在，通常在青春期、妊娠期或哺乳期在性激素的影响下出现症状。患者抱怨月经周期依赖性组织肿胀、不适和活动受限，但也有美容问题[4]。超声检查是关键的诊断方法，显示类似原位乳腺组织的低回声分隔组织。超声检查有助于排除鉴别诊断，如淋巴结病或脂肪瘤[6]。在文献中，发现了关于家族发病率以及与心血管或肾脏异常、肾脏肿瘤或三体21的巧合的报告[2，4，7]。虽然这些相关性尚未得到证实，但建议进行腹部超声检查以进行诊断性随访。异位乳腺组织经历与原位乳腺相同的生理和病理变化。其中包括良性（乳腺炎，纤维腺瘤，错构瘤）以及恶性（癌）发展[1，4，8，9]。主要并发症是乳腺癌，占所有乳腺癌的0.3%[10]。在组织学上，这些大多数是未另外指明（NOS）的癌（72%），其次是
Polymastia is a rare condition of the breasts, affecting approximately 2–6% of all women and 1–3% of all men. Onethird of the affected individuals have more than one area of accessory breast tissue [1]. Two women presented to a dermatological outpatient clinic complaining about lumps in their axilla. The first patient was a 25-year-old woman who had noticed for 2 years a lump in her right axilla which restricted free motion. She assumed it was a lymph node. Clinical examination revealed a soft, movable 4 × 4 cm nodule. Sonographic examination revealed a soft tissue mass without increased perfusion. The second patient was a 40-year-old woman who complained of intermittent bilateral axillary pain, which had first occurred following bilateral subcutaneous curettage of the axillary sweat glands in 2009. The patient noticed menstrual-cycle-related swelling and discomfort. Small moveable subcutaneous soft tissue masses were palpable in both axillae (Figure 1). Sonographic examination suggested the nodules resembled orthotopic mammary tissue (Figure 2). Clinical differential diagnostic considerations included lipoma or lymphadenopathy. In the second patient, postoperative changes such as adipose tissue necrosis, foreign body granuloma or connective tissue fibrosis had to be considered. Sonographic examination led to the suspected diagnosis of ectopic mammary tissue. Because the nodules caused discomfort and to confirm the diagnosis, we recommended surgical removal in both cases. The affected tissue was excised in the first women. In the second, only a deep excisional biopsy was performed for diagnostic clarification. Histologically the specimens from both patients revealed multiple excretory ducts and acini of apocrine glands within a partially fibrotic connective tissue in a configuration typical of mammary tissue (Figure 3). Diagnosis of ectopic mammary tissue was confirmed. Acccessory breasts are an anomaly in which parts of the embryonic mammary ridge persist. The embryonic milk line arises ontogenetically, from epidermal thickenings during the first month of embryonic development; they condense at the beginning of the second embryonic month to form the mammary ridges. These extend bilaterally from the axilla to the groin. Initially a number of glands develop, all of which, Clinical letter except for one located in the mid-thoracic region, degenerate at the beginning of the third embryonic month. The remaining gland forms the primordium of the latter mammary gland [2, 3]. Persistence of other parts of the mammary ridge may lead to polythelia (accessory nipple) or polymastia (accessory mammary gland). Polymastia may occur as glandular (mamma aberrata) or complete polymastia (mamma accessoria) [2]. Glandular polymastia or accessory mammary tissue features an isolated parenchymal mass without a mamilla, usually located in proximity of the breast, but potentially also in the axillary, vulvar, inguinal or other areas [2, 4, 5]. The ectopic mammary tissue is present from birth, and usually becomes symptomatic under the influence of the sexual hormones during puberty, pregnancy or lactation. Patients complain of a menstrual cycle-dependent tissue swelling, discomfort and restriction of movement, but also of cosmetic problems [4]. Sonographic examination is the key diagnostic method, showing hypoechoic septate tissue in analogy to orthotopic mammary tissue. Ultrasonographic examination serves to rule out differential diagnoses such as lymphadenopathy or lipoma [6]. In the literature, reports about familial incidence as well as a coincidence with cardiovascular or renal anomalies, kidney tumors or trisomia 21 are found [2, 4, 7]. Although those associations have not been proven, sonographic examination of the abdomen is recommended for diagnostic follow-up. Ectopic mammary tissue undergoes the same physiological and pathological changes as does the orthotopic mammary gland. Among those are benign (mastitis, fibroadenoma, hamartoma) as well as malignant (carcinoma) developments [1, 4, 8, 9]. The main complication is carcinoma, of the breast, which accounts for 0.3% of all mammary carcinomas [10]. Histologically, these are mostly not otherwise specified (NOS) carcinomas (72%), followed by