Cystic Echinococcosis of the Breast - Diagnostic Dilemma or just a Rare Primary Localization

Abstract

Introduction: Although the liver and lung are the most frequently affected organs in cystic echinococcosis, the cysts may develop in any viscera and tissues. Breast is a rare primary localization with few cases described in the literature. We present an updated and systematic review and discuss the possible mechanisms of spreading, diagnostic and treatment options.Materials and methods: We performed a literature search in PUBMED using the key words ‘hydatid disease’, ‘cystic echinococcosis’ and ‘breast echinococcosis’ without time limitation. Only studies reporting breast cystic echinococcosis were included.Results: Overall, 121 cases with cystic echinococcosis and 2 with alveolar echinococcosis were reported. A total of 52 cases were included in the analysis. The mean size of cysts was 5.5 cm (range 1.7-12). The most common clinical presentation was painless lump presented from 4 months to 19 years before the final diagnosis. Most cases had isolated breast CE, few cases had synchronous localizations – femoral, thigh and lung, and previous liver CE. Most were active CL and CE1-2 cysts (72%). Ultrasound was used in 83%, followed by mammography (35%). Fine needle aspiration was reported in 27 cases with positive finding in 59%.Conclusions: In cases with cystic breast lesions from endemic regions we recommend the US as a gold standard. CT and MRT are more accurate but expensive tools without the potential to change the surgical tactic. In contrast to the other localizations of CE, complete excision of the cysts is the best diagnostic and treatment approach.

Hidatidosis quística simulando una neoplasia hepática invasiva

“…Los hallazgos histopatológicos reportados en la literatura de los especímenes resecados, se caracterizan por la presencia de una pared del quiste que tiene tres componentes estructurales: una membrana laminada acelular externa (1 mm de espesor), una membrana germinal (revestimiento nucleado transparente) y protoescólices, adheridos a la membrana y sobresaliendo de ella, los cuales son ovoides y contienen ganchos (birrefringentes bajo luz polarizada) y una ventosa. También existe una capa fibrótica externa con tejido de granulación con aumento de eosinófilos [9].…”

“…Radiológicamente el parásito puede imitar una lesión neoplásica con componente quístico, como el cistoadenoma y el cistoadenocarcinoma [5][6][7][8]. Los hallazgos histopatológicos están dados por la presencia de la pared del quiste con diferentes com-ponentes estructurales, como la membrana laminada acelular externa, la membrana germinal y protoescólices, además de una capa fibrótica externa con tejido de granulación con aumento de eosinófilos [9]. El tratamiento incluye la administración de antiparasitarios, procedimientos mínimamente invasivos, resección quirúrgica y, en algunos casos, un enfoque conservador [10].…”

Pre-operative diagnosis of hydatid cyst in the breast: A case report of a rare entity and review of literature

“…9 A total of 121 cases of breast hydatid cyst were reported in the literature up to October 2018. 5 We found 10 more cases of hydatid cyst in the breast till date on PubMed search, making a total of 131 cases. Our case of hydatid cyst in the breast would add upto 132 recorded cases, according to the best of the authors' knowledge.…”

“…The recent consensus statement published by WHO Informal Working Group on Echinococcosis (WHO-IWGE) recommended ultrasound examination as a very useful screening tool ,having a sensitivity and specificity of 93-98% and 88-90% in endemic areas. 5 Gharbiet al have described five types of ultrasound findings for hydatid disease: a purely cystic lesion, cyst with split wall (detached membrane giving water lily sign) 4 fluid collection with septa ( daughter cysts), and a completely solid appearance and reflecting walls with calcifications. 2 Differentials for hydatid cyst on ultrasound include simple cyst, complex cyst, solid mass, intra cystic carcinoma, inflammatory carcinoma and mastitis.…”

“…Definite diagnosis is difficult to make preoperatively as hydatid cyst in breast can be confused clinically with other breast lesions and due to its rare occurrence, it is usually not included in the differential diagnosis of breast lumps. Mammography and ultrasonography (USG) features are also non-specific and it may be confused with simple or complicated breast cysts, unless the typical features of a hydatid cyst are present Only 131 cases of hydatid cyst in the breast have been published in literature 5 and in the majority of cases, diagnosis was only possible post-operatively. 6 The diagnosis of breast hydatid cyst by fine needle aspiration has been reported with no urticarial or anaphylactic reactions, which are documented complications of this procedure.…”