Bencherifi Younes¹, Imane Ziad*^,2, El Karoini Doha², Tossi Sara¹, Benhessou Mustapha¹, Ennachit Mohamed¹ and El Karroumi Mohamed¹

¹Professor in the Department of Gynecology and Obstetrics at the Ibno Rochd University Hospital in Casablanca, Morocco
²Resident Physician, Department of Gynecology and Obstetrics, at Ibno Rochd University Hospital, Casablanca, Morocco

*Corresponding author: Ziad Imane, Resident Physician, Department of Gynecology and Obstetrics, at Ibno Rochd University Hospital, Casablanca, Morocco

Abstract

---

Molluscum pendulum, is a benign asymptomatic fibroepithelial tumor that rarely appears on the areola-nipple plate. This tumor rarely exceeds 2 cm. The nipple is an unusual site for it. The soft fibroid may arise spontaneously or following traumatic implantation. We report the case of a patient with swelling at the nipple-areolar plate with a review of the literature.
Keywords: Breast Angiosarcoma; Radiotherapy; Radiation-Induced Tumour

Introduction

---

Molluscum pendulum, is a benign fibroepithelial tumor that rarely appears on the areola-nipple plate. It is a benign, asymptomatic mesenchymal tumor that rarely exceeds 2 cm. This tumor develops more in certain areas such as the face, neck, armpit and groin [1]. Although it is a common lesion, the nipple is an unusual site for it [2]. The soft fibroid may arise spontaneously or following traumatic implantation. We report the case of a patient with swelling at the nipple-areolar plate with a review of the literature.

Case Report

---

Mrs. Y.B., 52 years old woman, followed in dermatology for neurofibromatosis lesions since childhood, type 1 diabetes on insulin; with no surgical history, for seven months she has had a lesion on the areola of the left breast, progressively increasing in size and forming a body with the areola, which is not painful and has the same pigmentation as the nipple. The clinical examination was unremarkable apart from a hyperpigmented lesion measuring 3 x 3 cm on the left areola, which was soft and painless (Figure 1).
A mammography and breast ultrasound were carried out and found to be without abnormality. We suggested that this growth was either a lesion from her known pathology or a supernumerary nipple or a molluscum pendulum or a mamelon hyperkeratosis or an epidermised botriomycoma. A simple surgical excision was performed. Histological examination revealed a papillomatous lesion under a normal or slightly acanthosis epidermis and loose connective tissue. The squamous layer was discreetly keratotic and rested on an axis (Figure 2).

Discussion

---

Molluscum pendulum is a benign fibrous skin tumor, most common in women. Clinically, it presents as a small, soft, pedunculated, flesh-colored growth that is often sub-centimetric but can sometimes exceed 1cm [3]. Preferential sites are the flexion zones, but it can also occur on the eyelids. The narrow base is suggestive [4].
The etiology of acrochordon is unknown, but it is assumed that they generally occur in localized areas with sparse elastic tissue resulting in atrophic or sessile lesions. Hormonal imbalances also appear to be a co-factor in their development. As well as other factors that encourage their growth, such as tissue growth factor, epidermal growth factor and infection. They increase mainly with age [5].
Giant molluscum pendulum is a rare entity. If it occurs on the breast, an underlying lesion should be investigated. Their incidence increases in families or in acanthosis nigricans, tuberous sclerosis or general diseases such as acromegaly and diabetes [6].
The differential diagnosis of benign nipple lesions is broad and includes supernumerary nipple, neurofibroma, adenoma, papilloma, wart and epidermal cyst [7]. Entities such as adenomas, neurofibromas, pedunculated nevi and fibroepithelial polyp of the nipple present in the same way macroscopically and require histological examination for a definitive diagnosis.
Withholding treatment remains the treatment of choice if the lesions are asymptomatic, unless they show signs of irritation, particularly from rubbing, or for aesthetic reasons. Treatment is based on simple excision and primary closure [8]. The advantages of surgical excision include improved aesthetics, reduced irritation and pain, and patient comfort.

Conclusion

---

Molluscum pendulum or soft fibroma of the areola is a rare but benign tumor that is correctly managed by simple surgical excision. As this tumor is rarely reported in the literature, it is important to differentiate this lesion from other benign and malignant tumors which require extensive management.
Patient's consent: Written informed consent was obtained from the patient for publication and any accompanying images.

References

---

1. Chiorean, RM Pintican, M Szep, D Feier, L Rogojan, B Fetica, et al. (2020) Nipple ultrasound: a pictorial essay. Korean J Radiol. 21(8): 955-966. [PubMed.]
2. BK Arora. (2019) A clinical case of large fibroepithelial polyp of breast nipple. Int J Case Rep Images. 10. [Ref.]
3. Vishal G, Grover C. (2021) “Molluscum” Conditions in Dermatology. Indian Dermatol Online J. 12(6): 962-965. [Ref.]
4. M Shaaban, EP Turton, W Merchant. (2013) Unusual case of a large fibroepithelial stromal polyp presenting as a nipple mass. BMC Res Notes. 6: 345. [PubMed.]
5. BF Seo, SN Jung. (2012) Fibroma of the nipple. Breast J. 18(5): 494-495. [PubMed.]
6. HS You, SM Park, HH Cho, WJ Kim, JH Mun, M Song, et al. (2015) A case of soft fibroma of the nipple with a cauliflower-like appearance. Ann Dermatol. 27(1): 102-103. [Ref.]
7. N Nakai, R Itoh, N Katoh. (2013) Skin tag of the nipple with blister formation: two case reports. J Dermatol. 40(11): 946-947. [PubMed.]
8. RA Agha, T Franchi, C Sohrabi, G Mathew, A Kerwan, A Thoma, et al. (2020) The SCARE 2020 guideline: updating consensus surgical Case Report (SCARE) guidelines. Int J Surg. 84: 226-230. [PubMed.]