darkhorse
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A 17-year-old girl comes to the clinic because of a "reddish bump" on her abdomen. She states that she has had it for as long as she can remember, but her current boyfriend is concerned that it may be "cancer". She has no other complaints and does not take any medications other than oral contraceptive pills for birth control. Her grandfather has malignant melanoma of the eye and her mother has breast cancer. Physical examination shows a 0.4cm pinkish-brown, raised lesion on the left periumbilical region, 3cm lateral to the umbilicus. A small amount of soft tissue is palpated beneath the lesion. It is directly on an imaginary line that you can trace along the body from the left axilla to the left inguinal region. The remainder of the physical examination is normal. In discussing this lesion with the patient, you should inform her that
A. coal tar ointment and ultraviolet light therapy is an old but useful treatment
B. she has a 70% chance of having a kidney and/or urinary tract defect
C. the lesion needs to be removed immediately because it is precancerous
D. this is most likely a congenital defect that can be removed for cosmetic purposes
E. this needs to be removed immediately and she will need radiation therapy
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| gr8doc
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I get a feeling that this might be a supernumarary breast, I would have gone for D.
I'll appreciate other views.
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| neuroblastoma
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D. this is most likely a congenital defect that can be removed for cosmetic purposes
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| sprint123
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Polymastia along the milk line.......?
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| cool doctor
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yes I agree with you this is extra breast tissu the answer is D
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| darkhorse
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The correct answer is D. This patient most likely has an accessory nipple (polythelia) and extraglandular breast tissue (polymastia), which are present in approximately 2% to 5% of the population. They usually occur along the "milk line," which is an embryologic line that extends from the axilla to the inguinal region. Normal breasts form along this line and other areas of breast tissue and accessory nipples can too. Patients often think that they are "moles" and generally are only concerned about the cosmetic appearance. They can be simply removed as an outpatient, and additional treatment is not usually necessary.
Coal tar ointment and ultraviolet light therapy is an old but useful treatment (choice A) is a true statement concerning psoriasis, not polythelia or polymastia. Psoriasis is characterized by erythematous plaques with silvery scales. It typically occurs on the elbows, knees, lower back, and scalp.
Some studies have shown an association between polythelia, polymastia and kidney and urinary tract defects. However, this is only in about 8% of the cases. It is therefore incorrect to tell her that she has a 70% chance of having a kidney and/or urinary tract defect (choice B). Further kidney and urinary tract evaluation may be indicated.
Accessory nipples (polythelia) and extraglandular breast tissue (polymastia) are not typically considered precancerous, therefore it is incorrect to tell her that the lesion needs to be removed immediately because it is precancerous (choice C). They are usually removed for cosmetic purposes.
Accessory nipples (polythelia) and extraglandular breast tissue (polymastia) are not typically considered malignant and therefore it is incorrect to tell her that this needs to be removed immediately and that she will need radiation therapy (choice E).
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| gr8doc
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