Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 908
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 
     


 
 Table of Contents  
DISPATCHES
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 148-150  

Cysticercosis of breast


1 Department of Pathology, ESIC Model Hospital cum Occupational Disease Center, Indore, Madhya Pradesh, India
2 Department of Pathology, MGM Medical College, Indore, Madhya Pradesh, India
3 Department of Surgery, ESIC Model Hospital cum Occupational Disease Center, Indore, Madhya Pradesh, India

Date of Submission08-Apr-2013
Date of Web Publication26-Nov-2013

Correspondence Address:
Narendra Kumar Gupta
Departments of Pathology, ESIC Model Hospital cum Occupational Disease Center, Indore, Madhya Pradesh
India
Login to access the Email id


DOI: 10.4103/2229-5070.122146

PMID: 24471001

Rights and Permissions
   Abstract 

Human cysticercosis, a parasitic infection caused by cysticercus cellulosae. This results from ova being swallowed or getting asses to human stomach by regurgitation from own adult worm. The larvae are liberated in stomach, penetrate the intestinal mucosa and carried to many parts of the body where they form cysterci, 0.5-1 cm cyst that contain the head of young worm. They do not grow further or migrate. The common sites are skeletal muscle, subcutaneous tissue, brain and eye. Breast is an uncommon site.

Keywords: Cysticercosis, FNAC, parasite


How to cite this article:
Gupta NK, Panchonia A, Jain D. Cysticercosis of breast. Trop Parasitol 2013;3:148-50

How to cite this URL:
Gupta NK, Panchonia A, Jain D. Cysticercosis of breast. Trop Parasitol [serial online] 2013 [cited 2019 Jul 20];3:148-50. Available from: http://www.tropicalparasitology.org/text.asp?2013/3/2/148/122146

Human cysticercosis, a parasitic infection caused by cysticercus cellulosae, the larval form of Taenia solium. It is present world-wide, but is most prevalent in Mexico, Africa, South-East Asia, Eastern Europe, and South America. [1]

In the normal cycle of T. solium, humans are definitive hosts and pigs are intermediate hosts. Man occasionally serving as larval host of T. solium, becomes infected either drinking contaminated water or by eating uncooked vegetables infected with eggs or by internal regurgitation of eggs into the stomach due to the reverse peristalsis, when the intestine harbors a gravid worm. The larvae are liberated in stomach, penetrate the intestinal mucosa and carried to many parts of body where they form cysterci, 0.5-1 cm cyst that contain the head of young worm. They do not grow further or migrate. The human is dead end host.

The common sites are skeletal muscle, subcutaneous tissue, brain and eye. Breast is an uncommon site.


   The Case Top


A 38-year-old female presented with lump in left breast of one year duration in upper outer quadrant of lemon size. Initially, it was of pea size but gradually increasing. It was associated with intermediate pain. Lump was non-tender. The right breast was normal. Breast sonography was performed using a high-frequency transducer of 11-14 MHz. Imaging demonstrated a well-defined cystic lesion measuring 14 mm × 12 mm in upper outer quadrant of left breast. The cystic lesion contained an echogenic nodule measuring 10 mm. There was a hypoechoic area measuring 30 mm × 20 mm surrounding the cystic lesion. Fine needle aspiration cytology (FNAC) showed a mixed inflammatory cell infiltrate composed of eosinophils, plasma cells and lymphocytes. Larval fragment of cysticercus were also identified in smear, which composed of a parenchymal layer of loose fibrillary stroma with numerous round to oval nuclei. Mammography was not carried out. Lump was removed surgically.

On pathological examination, grossly, the specimen consists of cystic nodular swelling measuring 3 cm × 2 cm × 2 cm. External surface were unremarkable. Cut surface show serous fluid with white mass. Microscopically the section shows fibromuscular tissue with dense infiltrate of plasma cells, lymphocytes, and eosinophils. The scolex was identified; suckers and hooklets were also visible [Figure 1] and [Figure 2]. Cyst wall was lined with three layers namely corrugated cuticular layer with hair such as protrusions (microtrichia) in contact with host tissue, a thin middle cellular layer and a thick inner layer containing of loosely packed network of small canaliculi. Multinucleated giant cells and foreign body granuloma were seen in the cyst wall.

The patient had an uneventful post-operative recovery. She was given albendazole 400 mg twice daily for 28 days.
Figure 1: FNAC (H and E, 400) showing larval fragment of cysticercus in smear, which composed of loose fibrillary stroma with numerous round to oval nuclei

Click here to view
Figure 2: H and E stained section (×100) showing cyst wall enclosing structure cystecercus cellulose with 1.Suckers 2. Hooklets

Click here to view



   Conclusions Top


Human cysticercosis is larval manifestation of the cestode T. solium. The cysticercus can be found in any organ, but is especially common in skeletal muscle, subcutaneous tissue, brain and eyes. Still it is unusual for cysticercosis to occur in breast. In a study in Nepal, out of 23,402 biopsy, 62 cases of cysticercosis have been detected, with 8% cases located in breast. [2] In India 8,364 breast aspirates, demonstrated only eight cases of cysicercosis. [3]

Breast cysticercosis is difficult to diagnose because the clinical manifestations are non-specific. Fully developed cysticerci are opalescent, milky white cysts, elongated to oval and about 1 cm in diameter. The cyst contains fluid and single invaginated scolex. The scolex has a rostellum, four suckers and 22-32 small hooklets. The cyst wall is multilayered, 100-200 mm thick, and covered by microvilli. The outer cuticular layer appears smooth and hyalinized and is frequently raised in projections. [4] Beneath the tegument is a row of tegumental cells. The inner layer or parenchyma is loose and reticular, containing mesenchymal cells and calcerous corpuscles. [5] The calcerous corpuscles are a unique feature of cestode tissue. These spherical, non-cellular masses occur in the parenchyma and are especially prominent in larval cestodes. The corpuscles take on a bluish purple color in H and E stain. [6]

Cysticercosis of the breast is difficult to differentiate from neoplastic lesion on clinical grounds alone. [7] The cytomorphological identification of larvae in FNAC smears has widened the diagnostic utility of FNAC. [4],[7],[8] Suspicion about parasitic lesion starts whenever clear fluid with the presence of eosinophils, neutrophils, palisading histiocytes and giant cells is aspirated. [9],[10] The diagnosis of cysticercus is made when fragments of larval cuticle and parenchyma are identified. Viable cysticerci may not cause any inflammatory response. However, when they degenerate, there is an infiltration of inflammatory cells, associated with development of foreign body granulomas. The viable cyst yields clear fluid and shows fragment of bladder wall, including calcareous corpuscles and detached single hooklets. [11] In all inflammatory/cystic/inflammatory cystic lesions, the possibility of cysticercosis should be kept in mind. [12]

 
   References Top

1.Jain BK, Sankhe SS, Agrawal MD, Naphade PS. Disseminated cysticercosis with pulmonary and cardiac involvement. Indian J Radiol Imaging 2010;20:310-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Amatya BM, Kimula Y. Cysticercosis in Nepal: A histopathologic study of sixty-two cases. Am J Surg Pathol 1999;23:1276-9.  Back to cited text no. 2
[PUBMED]    
3.Sahai K, Kapila K, Verma K. Parasites in fine needle breast aspirates: Assessment of host tissue response. Postgrad Med J 2002;78:165-7.  Back to cited text no. 3
[PUBMED]    
4.Vuong PN. Fine needle aspiration cytology of subcutaneous cysticercosis of the breast. Case report and pathogenic discussion. Acta Cytol 1989;33:659-62.  Back to cited text no. 4
[PUBMED]    
5.Kamal MM, Grover SV. Cytomorphology of subcutaneous cysticercosis. A report of 10 cases. Acta Cytol 1995;39:809-12.  Back to cited text no. 5
[PUBMED]    
6.Ash LR, Orihel TC. Larval Cestode Parasite in Humans: Atlas of Human Parasitology. 3 rd ed. Chicago, IL: American society of Clinical Pathologists; 1990. p. 236-7.  Back to cited text no. 6
    
7.Kung IT, Lee D, Yu HC. Soft tissue cysticercosis. Diagnosis by fine-needle aspiration. Am J Clin Pathol 1989;92:834-5.  Back to cited text no. 7
[PUBMED]    
8.Verma K, Kapila K. Fine needle aspiration diagnosis of cysticercosis in soft tissue swellings. Acta Cytol 1989;33:663-6.  Back to cited text no. 8
[PUBMED]    
9.Patnayak R, Kalyani D, Rao IS, Prayaga A, Sundaram C, Jena A. Cysticercosis: The hidden parasite with short review of literature. Internet J Infect Dis 2007;6:1.  Back to cited text no. 9
    
10.Agrawal KC, Mishra DP, Das PK. Cysticercosis diagnosed by fine needle aspiration cytology. Acta Cytol 2004;48:471-2.  Back to cited text no. 10
[PUBMED]    
11.Handa U, Garg S, Mohan H. Fine needle aspiration in the diagnosis of subcutaneous cysticercosis. Diagn Cytopathol 2008;36:183-7.  Back to cited text no. 11
[PUBMED]    
12.Adhikari RC, Aryal G, Jha A, Pant AD, Sayami G. Diagnosis of subcutaneous cysticercosis in fine needle aspirates: A study of 10 cases. Nepal Med Coll J 2007;9:234-8.  Back to cited text no. 12
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]


This article has been cited by
1 Uncommon Infections in the Breast
Monica D. Agarwal,Shambhavi Venkataraman,Priscilla J. Slanetz
Seminars in Roentgenology. 2017;
[Pubmed] | [DOI]
2 A Classic Case of Subcutaneous Cysticercosis: A Rare Case with Sonological Findings and Review of Literature
Naren Satya Srinivas M.,Kamala Retnam Mayilvaganan,Amogh V.N.,Balakrishna B.V.,Munnangi Satya Gautam,Ivvala Sai Prathyusha
Polish Journal of Radiology. 2016; 81: 478
[Pubmed] | [DOI]
3 EXPERIMENTAL SUBCUTANEOUS CYSTICERCOSIS BY Taenia crassiceps IN BALB/c AND C57BL/6 MICE
Íria Márcia PEREIRA,Sarah Buzaim LIMA,Aline de Araújo FREITAS,Marina Clare VINAUD,Ruy de Souza LINO JUNIOR
Revista do Instituto de Medicina Tropical de São Paulo. 2016; 58(0)
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   The Case
   Conclusions
    References
    Article Figures

 Article Access Statistics
    Viewed2050    
    Printed48    
    Emailed0    
    PDF Downloaded82    
    Comments [Add]    
    Cited by others 3    

Recommend this journal