Vulvar Nodules: A Rare Presentation of Mastocytosis

Abstract

Background: While nipple discharge is common in adolescents, there are few reports of areolar discharge in the literature. We describe two cases of bilateral areolar discharge and inflammation with no underlying pathology. Cases: The cases involved healthy, 13 and 16-year old girls who presented to pediatric and adolescent gynecology (PAG) clinic with breast swelling and areolar discharge that caused significant patient distress and anxiety. The first case described left breast swelling and pain, with subsequent development of copious non-bloody, clear serous areolar discharge, followed by similar symptoms on the contralateral breast seven weeks later. Physical exam was notable for erythema, edema, and excoriation of the entire areola bilaterally, with diffuse weeping clear, yellowish discharge along the medial aspect of the areola. The second case initially presented to the PAG clinic with unilateral areolar swelling followed by weeping yellow discharge and development of bilateral symptoms over a two-week period. On examination copious yellow serous discharge was noted from the entire areola bilaterally extending approximately 1cm radially to adjacent breast tissue, where erythema and sub-centimeter areas of skin sloughing were also noted. There were no palpable breast masses, axillary lymphadenopathy, or expression of nipple discharge for either case. Cultures of the discharge were negative for bacteria. Breast ultrasound was unremarkable in one case and not performed in the other. Thyroid stimulating hormone (TSH), and prolactin (PRL) were normal. Both cases were treated with a short course of oral clindamycin, triamcinolone cream, and daily use of chlorhexadine gluconate 4% liquid soap with complete resolution of symptoms. Comments: There are few cases of areolar discharge described in the liter

Yellowish Nodules on the Vulva in a 6-year-old Girl: A Quiz

“…The vulvar location is exceptional; 17 cases were found in the literature, including some of vulvar mastocytoma and vulvar swelling, but other cases (1-8) featured this particular multiple papulo-nodular clinical aspect, which requires a differential diagnosis with Langerhans histiocytosis (9) and other causes of vulvar papulo-nodules, such as pseudo-verrucous papules linked to local irritation, condylomas, molluscum contagiosum, xanthomas and juvenile xanthogranulomas (5,6).…”