Syringomatous Tumour Presenting as Inversion of a Supernumerary Nipple

Syringomatous tumour (SyT) is a rare type of benign locally infiltrative tumour with debated origin. Because of the growth pattern, SyT can be mistaken for a malignant tumour, and it is therefore important to keep this diagnosis in mind. This case presents a woman with two supernumerary nipples on each side of the abdomen. One of the nipples was inverted with a small palpable firm mass in close relation to the nipple, leading to referral to the breast surgery department. SyT occurring in a supernumerary nipple and presenting with the symptoms described in this case has to our knowledge never been described previously.

SUPERNUMERARY NIPPLE OR PAPPILOMA?

Supernumerary nipples can be found in approximately 1 % of women. During the second and the third months of embryonic development when the regression of ectodermal thickening of mammary line takes place, incomplete regression with remaining of some foci may occur. These foci can further develop into a supernumerary breast or a supernumerary nipple. In this article, we would like to present five cases of supernumerary nipples. In 80% of cases, there was a single unilateral supernumerary nipple located along the right mammary line. In all the described cases this minor defect was efficiently excised for cosmetic purposes.

A Supernumerary Nipple-Like Clinical Presentation of Lymphangioma Circumscriptum

Lymphangioma circumscriptum is a superficially localized variant of lymphangioma. The characteristic clinical presentation is a “frogspawn” grouping of vesicles or papulovesicles on the proximal limb or limb girdle areas. Though most lymphangiomas develop congenitally, the lymphangioma circumscriptum subtype is known to present in adults. We report a case of lymphangioma circumscriptum on the left inframammary area of an African American female with an unusual supernumerary nipple-like clinical presentation. Our patient presented with a firm, smooth, hypopigmented papule, and the clinical diagnosis of keloid was made initially. However, she returned reporting growth of the lesion and was noted to have a firm, exophytic, lobulated, pink to skin-colored nodule. Histopathological examination demonstrated dilated lymphatic vessels, consistent with the diagnosis of lymphangioma. The presentation as a firm, hypopigmented papule and later exophytic, lobulated, skin-colored nodule in our case represents a clinical presentation of lymphangioma circumscriptum not previously described in the literature. Correct diagnosis in lymphangioma circumscriptum is vital, as recurrence following surgical resection and secondary development of lymphangiosarcoma and squamous cell carcinoma following treatment with radiation have been reported. Thus, it is important to consider lymphangioma circumscriptum in the differential of similar lesions in the future to allow appropriate diagnosis, treatment, and monitoring.