Primary Hydatid Cyst of Breast: A Case Report

 

Sutrakar S. K.1*, Bhargava O.P.2. Singh U. R.1, Lal S.1 and Azad K.L.3

1S.S. Medical College, Rewa­.

2N.S.C.B. Medical College, Jabalpur MP.

3Govt. Medical College, Jagdalpur CG.

ABSTRACT:

Cystic hydatid disease is caused by the Echinococcus granulosus parasite. Hydatid disease involving the breast is uncommon. The breast can be either a primary site of the disease or part of disseminated hydatisis. It is most commonly found in temperate climate than of tropical areas. Cysts develop in liver and lung is the commonest site, here we report a case of hydatid cyst breast, which clinically diagnosed as fibrocystic disease of breast pre-operatively and intra-operatively.

 

KEY-WORDS: Hydatid cyst, Breast lump.

 

 

INTRODUCTION:

Hydatid disease is caused by a tapeworm Echinococcus granulosus. It is widely prevalent in cattle breeding countries1. The liver is the most common site to be affected (70%), while lungs are the second commonest sites (20%)1,2. The breast is a rare primary site of hydatid disease and accounts for only 0.27% of cases2. A search of literature for prevalence of hydatid cyst of breast revealed 35 case reports and very few from India.

 

Case Report:

37-year-old Indian women presented with gradually progressive, painless lump in the left breast of 6 month duration. She did not give any history of injury or discharge from nipple and there was no family history of breast cancer. She was a housewife. Although, there was pet dog in the family, a history of keeping cattle’s in the house was present. Physical examination revealed a slightly mobile, measuring 4*3 cm in upper inner quadrant. It is firm in consistency, not fix to underlying structures, margins are well defined, and surface is smooth.

 

The right breast and both nipples were normal and there was no axillary or cervical lymphadenopathy. The chest x-ray and abdominal sonography were normal. All other investigation was within normal limit.

 

Pathological finding;

An excisional biopsy of the lump measured 4 X 2.5 X1.5 cm and consisted of fibro fatty tissue. Cut section revealed multilocular cyst measuring 2X1X1cm to 1X0.5X0.5 cm in diameter with a semi translucent, shiny inner surface (Fig.1). Microscopically, the cyst wall was made compressed breast tissue infiltrated by lymphocyte and eosinophils, within the lumen were seen laminated membrane, made up acellular chitenous material (Fig.2). She was discharged on the second postoperative day. No medical treatment was advised. She was followed up for three month and was asymptomatic.

 

 

Fig.1- Excisional biopsy of the lump.(Gross)

 

FIG.2- Microscopically, the cyst wall was made compressed breast tissue infiltrated by lymphocyte and eosinophils, within the lumen were seen laminated membrane, made up acellular chitenous material

 

DISCUSSION;

Hydatid cyst or Echinococcus is a parasitic disease caused by larval cestode (tapeworm) of genus Echinococcus. E. granulosus (cystic Echinococcus) is the most common species, but E. multilocularis (alveolar Echinococcus) and Evangelic (polycystic Echinococcus) also infect humans. The disease still continues to be a serious problem in temperate countries Australia and New-Zealand, as well as southern South America, Mediterranean countries, the southern and central parts of former soviet Uninon, central Asia, China, Australia, and parts of Africa3. The largest series of 20 hydatid cyst of the breast was reported in Tunisia4. There were few case reports and review literature of hydatid cyst of the breast from India reported by various authors6,7,10.

Echinococcus granulosus is a small tapeworm, measuring 3-6mm in length. It comprises of a scolex (“head”), “neck” and strobila consisting of 3 segments. The worm passes its life cycle in two hosts, the Dog, wolf, fox and jackal are the definitive host, the adult worm lives in the small intestine of these animals that discharge a large number of eggs in their faeces. The Dog is the optimum definitive host. The larval stage is passed in man giving rise to hydatid cyst. Humans can become contaminated with Echinococcus eggs via food intake. The eggs penetrate the intestinal mucosa and enter the blood circulation. Hydatid Cyst develops in different human tissue and organs. Fine needle aspiration cytology can enable accurate diagnosis by identification of the hooklets, scolices and certain part of laminated membrane. However, needle aspiration can cause a leakage from the cyst and can lead to parasitic dissemination and development of many new cyst formations or serious anaphylactic reaction3,5.The role of fine needle aspiration cytology in the diagnosis of Echinococcus is well documented8.

 

Hydatid cyst of the breast is rarely observed and differential diagnosis is very hard to make, based on physical and radiological examination only5,9. So for the confirmatory diagnosis histopathological examination is must, hydatid cyst should be considered in the differential diagnosis of all cystic masses in all anatomical locations, especially in the regions where the where the disease is endemic.10.

 

REFRENCES:

1.       Abi F, et Fares F, Khaiz D, Bouzidi A. Unusual localization of hydatid cysts. A propos of 40 cases. J Chir (Paris) 1989; 126: 307-12.

2.       Bengisun U, Ozaslan C, Kutlay J, Camur A, Demrci S. Primary hydatid cyst of the breast. Case report. Eur J Surg 1993; 159: 503-4.

3.       Radhi J M, Thavanthan MJ. Hydatid cyst presenting as a breast lump. Can J Sug 1990; 33: 29-30.

4.       Quedrago EG. Hydatid cyst of the breast. 20 cases. J Gynecol Obstet Reprod (Paris) 1986; 15: 187-94

5.       H. Uncu , S. Erekul, Hydatid Cyst of the breast. Acta chir belg,2007,107,570-571

6.       Gupta A, Jain BK, Taneja K, Navjeevan, Bhargav SK. Hydatid cyst of the breast. Trop Doctor 1994; 24: 173.

7.       Vasenwala SM. Echinococcosis involving the breast: diagnosis by fine needle aspiration cytology. Indian J Pathol Microbiol 1996; 39: 155-6.

8.       Kapila K, Verma K. Aspiration cytology diagnosis of echinococcosis. Diagn Cytopathol 1990; 6:301-3.

9.       Shatrughan P Sah, Chandra Shekhar Agrawal. Hydatid cyst presenting as a breast lump. Southeast asian J Trop Med Public Health. 2000; 31: 185-186.

10.     Das S, Kalyani R, Kumar U, Kumar HM. A varied presentation of hydatid cyst: a report of four cases with review of literature. Indian J Pathol Microbiol. 2007 Jul; 50(3):550-2. Review

 

Received on 14.07.2011

Accepted on 31.08.2011     

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Research J. Pharmacology and Pharmacodynamics. 3(6): Nov.-Dec., 2011, 305-306