Abstract

Ectopic breast is rare to occur but is more common in axilla. Ectopic breast occurs along the milk line from axilla to pubic symphysis. Ectopic breast is distinguished from axillary tail of the breast by its discontinuity from the normal breast in the former. Such ectopic breasts can be a seat of different lesions similar to breast tissue. Bilateral galactocele is not common, and such galactocele presenting as bilateral axillary swellings in a 30-year-old lactating woman is reported here for its rarity.

Introduction

Breast is the natural habitat for structural and functional lactiferous ducts and lobules. Sometimes such lactiferous ducts and sinuses are anatomically present in unnatural sites as accessory breast tissue in axilla, etc.¹ A symptomless accessory breast will be noticed when complaints of swelling, pain during pregnancy or lactation in the ectopic breast appear.¹ Accessory breast presenting in both axillae is uncommon. Galactocele occurring in both axillae is very rare² and our case appears to be 2nd case on review of available literature.

Case Report

A 30-year-old female complained of slowly growing painless axillary swellings on both sides since 3 months. The swellings started 10 days of postpartum period. There was no discharge from the swellings, no other swellings in the body and no fever. General examination revealed that respiratory, cardiovascular, renal, genital tract, central nervous system were normal. Local examination showed pendulous breasts and pressure on both breasts led to small droplets of white greasy fluid (milk) exuding from the nipple. No masses were found in both breasts.

Anterior portions of both the axillae showed well- defined swellings of 4 x 3 cm in right axilla and 3.5 x 3 cm in left axilla, soft in consistency and not attached to the surface skin. No other masses were palpable in the body (Figs. 1 and 2).

Laboratory investigations like X-ray, blood cell counts, erythrocyte sedimentation rate, serologic tests for contagious diseases were within normal limits. Fine needle aspiration cytology (FNAC) of both axillary swellings resulted in 30 mL of milky fluid from right axillary mass and 18 mL milky fluid from left axillary mass. Both axillary masses drastically diminished insize after aspiration. FNAC material when stained with Leishman, hematoxylin and eosin stains showed proteinaceous and fatty background with occasional benign cuboidal epithelial cell and lymphocytes. No malignant cells were found. 

The cytological features, prompted us to make a diagnosis of galacotocele of the ectopic breasts in right and left axillae. The patient was on follow-up and after 6 months, when she discontinued breastfeeding completely, both axillary swellings markedly diminished in size. 

Discussion

In an analysis of 176 breast lesions Sangeeta et al³ found only a single case of galactocele, while Desai et al⁴ found 1.76 cases among 212 cases indicating rarity of the lesion. During embryogenesis, the galactic band extends from the axillae to the groin. Breast tissue continues to form only in the pectoral region. Failure of regression of the remainder of this galactic band gives rise to ectopic breast tissue. Although, they can be located anywhere along the embryonic milk line extending from the axilla to the inguinal line, 60-70% of the accessory breast tissue occur in axilla.⁵

Accessory breast tissue should be differentiated from ‘axillary tail of Spence’, which is defined as the extension of the breast tissue to the axilla. Ectopic breast tissue is subject to the same physiological and pathological changes as in the normal breast tissue, including lactational changes, benign and malignant conditions.^1,2 When a female patient is diagnosed with a mass in axilla, a metastatic lymphadenopathy from breast cancer should be excluded first; lymph node involvement of lymphoma and granulomatous diseases (tuberculosis and sarcoidosis) should also be ruled out. Lesions like lipoma, sebaceous cyst, hidradenitis, cavernous hemangioma, venous malformation, lymphangioma are to be considered in the differential diagnosis.^2,6

Galactocele in axillae is differentiated from all other lesions by the finding of milk in the aspirated material in the axillary swelling, as in our case. The lesions usually regress in postlactational period and surgical excision brings cure to the disease.

Conclusion

A galactocele is to be considered as differential diagnosis of axillary masses in lactating women and a simple laboratory test of FNAC helps in the diagnosis.

About the Authors

KRK PRASAD*, A SARATH CHANDRA^†, G VIJAYARAMARAO^‡

*Professor, Dept. of Pathology, Mallareddy Medical College for Women, Suraram, Ranga Reddy, Telangana

^†Associate Professor, Dept. of Surgery and Cardiothoracic Surgeon, Mallareddy Institute of Medical Sciences, Suraram, Ranga Reddy, Telangana

^‡Pathologist and Director, Dept. of Pathology, Sigma Hospital, Shapur, Ranga Reddy, Telangana

Address for correspondence

Dr KRK Prasad, Professor, Dept. of Pathology 

Mallareddy Medical College for Women, Surarm, Ranga Reddy - 500 055, Telangana

References

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