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CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 242-244  

Axillary galactocele of ectopic breast: Ultrasound and mammography correlation


Department of Radiodiagnosis, JNMC, Wardha, Maharashtra, India

Date of Web Publication29-Jun-2018

Correspondence Address:
Sakshi Daga
Department of Radiodiagnosis, JNMC, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_154_17

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  Abstract 


Ectopic or accessory breast tissue may occur anywhere along the milk line or mammary ridge extending from axilla to groin. The most common location of the ectopic breast is axilla. This article reviews a case of 35-year-old female patient who presented to our hospital with left axillary lump. Mammography and ultrasonography were performed. Imaging findings were further confirmed with fine-needle aspiration cytology revealing left axillary galactocele.

Keywords: Accessory breast, galactocele, mammography, ultrasound


How to cite this article:
Daga S, Phatak S, Khan S, Rawekar S. Axillary galactocele of ectopic breast: Ultrasound and mammography correlation. Med J DY Patil Vidyapeeth 2018;11:242-4

How to cite this URL:
Daga S, Phatak S, Khan S, Rawekar S. Axillary galactocele of ectopic breast: Ultrasound and mammography correlation. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2020 Sep 26];11:242-4. Available from: http://www.mjdrdypv.org/text.asp?2018/11/3/242/235554




  Introduction Top


Accessory or ectopic breast is a variant that persists from embryonic development, may occur anywhere along the milk line or mammary ridge. Failure of the mammary ridge to regress results in the development of accessory or supernumerary breast anywhere along milk line. The most common location of the ectopic breast is axilla.[1],[2] It can undergo physiological or pathological changes similar to that of normal breast tissue. One such entity includes galactocele which is milk-filled cyst arising from blockage of a breast duct.[3] Galactocele mimics variety of benign and malignant breast conditions. Thus, their identification and distinction from other breast pathologies is must. Imaging techniques such as ultrasound and mammography help in the evaluation of such breast masses. Fine-needle aspiration cytology (FNAC) helps in further confirmation of galactocele. FNAC proves to be diagnostic as well as therapeutic.[4],[5]


  Case Report Top


A 35-year-old female patient presented at our hospital with the complaint of a palpable left axillary lump which was first noticed by her about a month back. There was no history of pain, skin changes or discharge from the lump. No previous h/o breast disease. No family history of breast malignancy present.

Physical examination revealed a mass of approximate size 5 cm × 4 cm in the left axilla. The mass was nontender, nonmobile with no evidence of discharge or inflammatory changes. The mass did not seem to be adherent to the chest wall. Examination of both the breast was normal. There was no e/o bilateral axillary lymphadenopathy.

She was further referred to the radiology department. Mammography [Figure 1]a and [Figure 1]b demonstrated 5.5 cm × 3.3 cm radio-opaque cystic lesion in the left axilla. Neither focal asymmetry nor architectural distortion of the lesion was noted. There was no evidence of microcalcification seen.
Figure 1: (a) Mammography cranio-caudal view of left breast: Normal. (b) Mammography medio-lateral view left axilla shows radioopaque cystic lesion. No e/o focal asymmetry or architectural distortion. No micro-calcification noted

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Ultrasound examination of the left axillary region [Figure 2] revealed a well-defined lesion of approximate size 4.8 cm × 3 cm of mixed echogenicity with internal septae and debris within. On Color Doppler ultrasound [Figure 3], there was no blood flow within the lesion; however, vascularity along the internal septae was seen.
Figure 2: Gray scale ultrasound examination of left axillary region revealed a well-defined lesion of approximate size 4.8 cm × 3 cm with mixed echogenicity. The lesion shows internal septae and debris within

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Figure 3: Color Doppler image showing vascularity in internal septations

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For further confirmation, fine-needle aspiration was performed. The milky fluid was aspirated. The aspirated materials were sent for laboratory evaluation. Cytopathology of aspirated material showed granular material, predominantly along with polymorphs, a few lymphocytes and macrophages. It also included lipid vacuoles and a few spindle hyaline tissues. No malignant cells were seen.

Based on imaging and pathological findings, diagnosis of left axillary galactocele was made.


  Discussion Top


Mammary ridges are two ventral ectodermal ridges that extend from axilla to inguinal region in fetal life. They undergo atrophy during embryogenesis except in thoracic region leading to breast development. However, the persistence of tissue along this mammary ridge may give rise to ectopic or supernumerary breast. Ectopic or accessory breast may arise from anywhere along the mammary ridge, the most common location being thoracoabdominal region. Rare sites may include face, neck, thigh, knee, vulva, etc. It may exist as a rudimentary tissue in body or extent to undergo complete glandular and ductal changes like a normal breast. Nipple-areola complex may or may not be present.[6]

Although it may be congenital, most of the females are unaware of their accessory breast. It may be detected incidentally on routine mammography screening. In some instances, patients may present with palpable lump, pain, or discomfort at such sites. Axillary ectopic breast may provide a diagnostic challenge as they mimic a variety of benign and malignant breast conditions such as lymphadenopathy, galactocele, lipoma, fibroadenoma, fibrocystic disease, or carcinoma breast.[7]

Presence of galactocele in an ectopic breast is a rare entity. Galactocele is the milk retention cyst that arises because of blockage of lactiferous ducts. Radiological procedures such as ultrasound, mammogram along with diagnostic aspiration helps in diagnosis of such entity. The mammographic appearance of galactocele depends on the fat content in the fluid (as milk secretion is fatty). It also depends on the amount of proteinaceous content, viscosity, and density of the fluid. On ultrasound, galactocele appears as a well-defined hypoechoic mass with echogenic walls. On occasion, they may present with indistinct margins and posterior acoustic enhancement. Color Doppler may show lack of blood flow within. Aspiration of milky fluid proves to be diagnostic as well as therapeutic. Cytopathological examination reveals fat or protein content, inflammatory cells, necrotic cells, and debris.

Most of the ectopic galactocele requires no intervention as they remain asymptomatic. However, in case of discomfort attempts to drain galactocele through fine-needle aspiration can be made.[8],[9]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Goyal S, Bawa R, Sangwan S, Singh P. Fibroadenoma of axillary ectopic breast tissue: A rare clinical entity. Clin Cancer Investig J 2014;3:242.  Back to cited text no. 1
  [Full text]  
2.
Velanovich V. Ectopic breast tissue, supernumerary breasts, and supernumerary nipples. South Med J 1995;88:903-6.  Back to cited text no. 2
    
3.
Winkler JM. Galactocele of the breast. Am J Surg 1964;108:357-60.  Back to cited text no. 3
    
4.
Geddes DT. Ultrasound imaging of the lactating breast: Methodology and application. Int Breastfeed J 2009;4:4.  Back to cited text no. 4
    
5.
Kocjan G. Needle aspiration cytology of the breast: Current perspective on the role in diagnosis and management. Acta Med Croatica 2008;62:391-401.  Back to cited text no. 5
    
6.
Patel PP, Ibrahim AM, Zhang J, Nguyen JT, Lin SJ, Lee BT, et al. Accessory breast tissue. Eplasty 2012;12:ic5.  Back to cited text no. 6
    
7.
Farrokh D, Alamdaran A, Yousefi F, Abbasi B. Galactocele in the axillary accessory breast mimicking suspicious solid mass on ultrasound. Case Rep Obstet Gynecol 2017;2017:4807013.  Back to cited text no. 7
    
8.
Dalal S, Dahiya R, Kant K. Spontaneous milk fistula from an accessory breast – An annoying complication. Internet J Surg 2008;18:2.  Back to cited text no. 8
    
9.
Joshi S, Dialani V, Marotti J, Mehta TS, Slanetz PJ. Breast disease in the pregnant and lactating patient: Radiological-pathological correlation. Insights Imaging 2013;4:527-38.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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