A 14-year-old girl is brought to the office for evaluation of a bump on her chest just below the right breast. The bump has been there for as long as she can remember, but it became a little larger 2-3 years ago. The bump also becomes tender just before she starts her menses. Menarche was at age 12. Her menses occur every 28 days and last 4-5 days. Examination shows Tanner stage 5 breasts. Both breasts and axillae appear normal. There is a soft, raised, hyperpigmented, 0.5-cm nontender lesion inferior to the right breast. Which of the following is the cause of this patient's presentation?

Question

A 14-year-old girl is brought to the office for evaluation of a bump on her chest just below the right breast.  The bump has been there for as long as she can remember, but it became a little larger 2-3 years ago.  The bump also becomes tender just before she starts her menses.  Menarche was at age 12.  Her menses occur every 28 days and last 4-5 days.  Examination shows Tanner stage 5 breasts.  Both breasts and axillae appear normal.  There is a soft, raised, hyperpigmented, 0.5-cm nontender lesion inferior to the right breast.  Which of the following is the cause of this patient's presentation?

Quizplus · Accepted Answer

11ec160b_3aa8_6b96_9249_f7b9494b16e2_MD0001_00 The most common congenital breast anomalies in women and men are accessory nipples (ie, polythelia, supernumerary nipple). They are due to failure of involution of the mammary ridge. Accessory nipples are usually asymptomatic. However, they may swell or become tender similar to normal breast tissue before or during menses, pregnancy, and lactation. They can occur anywhere along the embryonic milk line between the axilla and perineum and are bilateral in 50% of patients. Treatment is normally not needed. Histologically, the accessory nipple is identical to a normal nipple. Findings include hyperpigmentation, epidermal thickening, pilosebaceous structure of Montgomery areolar tubercles, smooth muscle bundles (areola), and possible mammary glands and multiple ducts. (Choice A) Congenital melanocytic nevi are caused by the clonal proliferation of benign melanocytes in utero. They can be raised and are hyperpigmented. (Choice B) Ephelides (eg, freckles) and solar lentigines are found on sun-exposed areas. Ephelides are caused by increased melanin production by melanocytes, whereas solar lentigo represents an increased proliferation of melanocytes themselves. They are both hyperpigmented and flat, but solar lentigines are often larger and occur in adults. (Choice D) Lipomas are benign fatty tumors contained within a fibrous capsule. They present as a flesh-colored, soft, and painless subcutaneous mass. (Choice E) Acrochorda, or skin tags, are benign and often pedunculated outgrowths of normal skin. They often develop in locations that experience frequent friction, such as beneath breast tissue or the axillae. Educational objective: Accessory nipples are the most common congenital breast anomaly resulting from failed regression of the mammary ridge in utero. They are usually asymptomatic but can become tender along with breast tissue during times of hormonal fluctuation. __________ References: Supernumerary nipples: an overview. (http://www.ncbi.nlm.nih.gov/pubmed/12769398)

A 14-Year-Old Girl Is Brought to the Office for Evaluation