A rare presentation of familial polymastia with associated polycystic ovarian morphology: a case report with a one-year follow-up

Abstract

Polymastia is a congenital anomaly resulting from incomplete embryological regression of the milk line. While relatively common, its familial occurrence and association with other morphological conditions present unique clinical scenarios. This report details a rare familial presentation of polymastia with concurrent polycystic ovarian morphology to highlight the need for holistic diagnostic evaluation. An 18-year-old female with a positive family history of polythelia presented with a left anterior axillary mass. Breast ultrasonography confirmed an accessory nipple with a distinct ductal system suggestive of left-sided polymastia. Abdominopelvic ultrasonography revealed bulky ovaries with tiny cysts (right ovary volume 6.61 CC, left ovary 9.69 CC), indicating polycystic ovarian morphology. The patient underwent complete surgical excision without complications. Histopathology demonstrated benign squamous epithelium with slight hyperkeratosis, pilosebaceous structures, smooth muscle, and breast lobules with ducts in the deep dermis, confirming no evidence of malignancy. At the one-year follow-up, the patient remained entirely asymptomatic with no recurrence and a satisfactory cosmetic outcome. This case emphasizes the clinical necessity of comprehensive systemic evaluation in patients with congenital anomalies. Surgical excision remains the definitive management for polymastia, successfully addressing cosmetic concerns and ruling out malignant changes.