Out of Sight, Not Out of Mind: Vulval Fibroadenoma Revealed

Ectopic breast tissue (EBT) represents a congenital anomaly caused by incomplete regression of mammary ridges at the time of embryonic development. Typically, EBT presents along the mammary line, although usually in the axillary region, it has been located occasionally in unusual sites such as the vulva. Though relatively rare, it is generally subject to a wide range of pathologies that afflict normal breast tissue, encompassing both benign and malignant transformations. Vulval fibroadenoma is a benign tumor originating from EBT and represents a particularly rare manifestation, with only a few cases reported in the medical literature. This report presents a case of a 35-year-old female patient presenting with cyclical pain in both breasts and a painful lump in the left vulvar region that had grown insidiously over a period of one year. Following the principles of triple assessment and physical examination and investigations for the vulval lump, it was diagnosed to be a fibroadenoma within ectopic breast tissue in the vulva. This case highlights the diagnostic challenge presented by this rare site of EBT in the vulva and has pointed out that EBT should be considered as a cause of vulvar mass. Because of the malignant change that may occur in EBT, early diagnosis and treatment are of paramount importance. This report adds to the few documented cases of EBT of the vulva and increases awareness among clinicians so as not to miss or delay such a rare condition.