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| DISPATCHES |
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| Year : 2013 | Volume
: 3
| Issue : 2 | Page : 148-150 |
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Cysticercosis of breast
Narendra Kumar Gupta1, Ashok Panchonia2, Dinesh Jain3
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 Submission | 08-Apr-2013 |
| Date of Web Publication | 26-Nov-2013 |
Correspondence Address:
Narendra Kumar Gupta
Departments of Pathology, ESIC Model Hospital cum Occupational Disease Center, Indore, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2229-5070.122146
 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 |
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 | |  |
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
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 | Figure 2: H and E stained section (×100) showing cyst wall enclosing structure cystecercus cellulose with 1.Suckers 2. Hooklets
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| Conclusions | | |
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]
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[Figure 1], [Figure 2]
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