Human cystic echinococcosis, a zoonotic infection caused by echinococcus granulosus, is still a largely extended public health problem in endemic regions like Morocco. Liver and lungs are the most commonly affected organs. Breast location is rare. Ultrasonography is specific and makes classification of the hydatid cyst.
We report a rare case of isolated breast hydatid cyct in 38 years old woman, Clinical and mammography examinations found a 5cm/3,5cm tender lump, with benign characteristics in the downer inter quadrant of the left breast, no calcifications was seen nether cutaneous modifications. Ultrasonography complement showed the very specific hydatid aspect of the lesion. Large cystectomy was performed with intact cyst. Histopathology confirmed the hydatid cyst. Post operatively patient was treated with albendazol.
Breast hydatid cyst must be in mind as differential diagnosis in benign breast pathology especially in endemic areas or in immigrant population. Ultrasonography is a very specific in identifying hydatid cyst and also in its classification.
Key words Imaging, hydatid desease, breast.
1. gynecology obstetrics department, university hospital Mohammed VI, Medecine Faculty, Cadi Ayyad University, Marrakech, Morocco.
RecievedSep 2 2013 AcceptedDec 3 2013 PublishedDec 11 2013
Citation Bouchra Fakhir, Khalil Abdi, Abderrahim Aboulfalah, Hamid Asmouki, Abderraouf Soummani (2013) Imaging of rare isolated breast hydatid cyst. Science Postprint 1(1): e00008. doi:10.14340/spp.2013.12C0003
Copyright©2013 The Authors. Science Postprint published by General Healthcare Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.1 Japan (CC BY-NC-ND 2.1 JP) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
FundingOur research is not supported by any funds.
Competing interestsNo relevant competing interests were disclosed.
Ethics statementPatient was informed and gives her consent about the use of her iconography. We respected absolute confidentiality and anonymity.
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Corresponding authorBouchra Fakhir
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Human cystic echinococcosis, a zoonotic infection caused by echinococcus granulosus, is still a public health problem in endemic regions like Morocco. Liver (75%) and lungs (15%) are the most commonly affected organs 1, 2. Breast location is rare, few cases are described in literature. Breast can rarely be the only primary site of infection or part of hydatidosis dissemination 3. Mammography is not specific for diagnosis, ultrasonography is more specific and can make hydatid cyst classification. We present a particular iconography of rare case of breast hydatid cyst to make medical community remember this special diagnosis. Breast hydatid cyst is often forgotten even in endemic areas.
A38 years old woman, mother of six, without any personal or familial medical history, discovered on herself a gradually increasing lump in her left breast. Clinical examination found a 5cm/3.5cm tender lump, without any inflammatory signs. No axillary nodes were found. Mammography was performed, showed a well defined homogeneous and bi-lobulated opacity in the downer inter quadrant of the left breast, no calcifications was seen neither cutaneous modifications (figure 1).
Ultrasonography complement showed the cystic nature of the opacity measuring 5.7 /1.8cm, with multiple swirling membranes; thick echogenic debris and echogenic areas (figure 2).
Hydatid nature of the lesion was suspected. Large cystectomy was performed with intact cyst (figure 3).
Histopathology confirmed the diagnosis showing amorphous densely-staining laminated chitinous material beside normal breast tissue. (figure 4).
Post operatively patient was treated with albendazol. Chest radiography and abdominal ultrasonography were normal, confirming the isolated character of the breast disease.
Although breast hydatidosis is rare, it should be considered as a differential diagnosis of breast lumps, especially in sheep raising countries and among endemic areas migrant populations. Mammography, ultrasonography and eventually magnetic resonance imaging can make initial diagnosis. Mammography shows a non specific homogeneous well circumscribed opacity 4, 5. The characteristic ring-shaped structures inside the mass can be seen in over-penetrated view 6. Ultrasonography classified hydatid cysts in five types 7. Type1 is pure fluid collection which must be differentiated from simple breast cyst. Type 2 is multi-vesicular multi-septated cyst which is very specific image of hydatid cyst. Type 3 is unilocular cyst with daughter cysts and detached laminated membranes floating in the cyst fluid. Our case is corresponding to type 3 which is particularly specific for hydatid cyst. Type 4 is heterogeneous echo patterns contains mixed hypo and hyperchoic degenerative contents with no daughter cysts, it must be differentiated from malignant tumor by further investigations. Type 5 is characterized by arch like thick calcified wall producing cone shaped shadow, calcification may occur partially or completely. Magnetic resonance imaging can show the association of the cyst with neighboring tissues, the internal laminar wall of the cyst and specific intraluminal daughter cysts 8. Complete cystectomy is recommended as surgical treatment for breast hydatid cyst, general investigation must be done to look for other location of hydatid disease particularly lungs and liver.
Ultrasonography findings can generally help to establish the diagnosis of breast hydatid cysts, but some cyst types make the differential diagnosis difficult. So familiarity with the imaging findings in endemic regions and also in immigrant populations is interesting in this context.
Thinks to all persons that participate to this work.
B.F: participates to patient care and writes the article.
K.A: participate to patient care and takes photos
A.A: made article correction.
H.A: made article correction
A.S: department in chief, makes team coordination.