Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 1409

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

BREAST IMAGING Table of Contents   
Year : 2004  |  Volume : 14  |  Issue : 1  |  Page : 57-60
Hydatid disease of breast


Govt. Medical College, Nagpur, India

Click here for correspondence address and email
 

   Abstract 

Hydatid disease is a well-known entity since the era of Hippocrates. Although breast is one of the rare sites for the occurrence of hydatid disease, it has been well evaluated with the various newer imaging modalities and its imaging features are well described in the literature. This essay describes various imaging features of an operatively proven case of hydatid disease of breast with review of literature.

Keywords: Hydatid disease, Breast

How to cite this article:
Taori K B, Mahajan S M, Hirawe S R, Mundhada R G. Hydatid disease of breast. Indian J Radiol Imaging 2004;14:57-60

How to cite this URL:
Taori K B, Mahajan S M, Hirawe S R, Mundhada R G. Hydatid disease of breast. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Jul 19];14:57-60. Available from: http://www.ijri.org/text.asp?2004/14/1/57/28557

   Discussion Top


Hydatid disease is a well-known entity since the era of Hippocrates. Hippocrates noted that 'when the liver filled with water and bursts…. The belly filled with water and the patient dies [1]'

In 1773 John Hunter made an accurate description of Hydatid diseases, noted that large and small hydatids were uniformly round and filled with clear water…. In a transparent bag….. of two coats… the inner surface covered with small hydatids… not so large as the heads of pins. Hence the name. Another medical bastardization of Latin and Greek, derives from Echinos. (Greek Hedgehog), Kokkos (Greek: Berry) Granulum (Latin: small grain) and Hydatids (Greek: drop of water)[1].

Because of its nature of having early asymptomatic phase and delayed presentation, early diagnosis is difficult. The real development in the diagnosis and management of the disease took place after the development of imaging techniques like ultrasound (US) after world war-II. Down the ages more advanced imaging modalities have made the pre operative diagnosis possible for the management of this disease. Hydatid disease of the breast is rare. However, it might constitute a potentially serious differential diagnosis of a breast lump in area endemic for this disease.

Hydatid disease is caused by a larva of Echinococcus granulosus and rarely Echinococcus multilocularis. The disease is endemic in central India. Due to its varied morphological presentations and involvement of various sites in the body it gives rise to varying clinical symptomatology. Painless local swelling is the most common presenting complaint in case of hydatid disease of breast. Man is usually an accidental host, primary hosts being Dogs, Sheep, etc. Hydatid disease can be found in any age group and any body sites. Common sites involved according to incidence are: Liver - 75%, Lungs-15%, Muscles - 04%, Kidneys - 02%, Spleen-02%, Bone-01%, Others 01% (e.g. Brain, Breast, Heart orbit, etc.) [2]. The breast is a rare primary site accounting for only 0.27% of all cases. [3] Although rare; hydatid disease should always be borne in mind in patients with palpable breast lumps, particularly in endemic country like India. Histologically hydatids consists of three layers-[1] Endocyst (Parasite component of capsule)- inner germinal layer giving rise to brood capsules. [2] Ectocyst (Cyst membrane) - substance secreted by parasite. [3] Pericyst (Host compnent) - organized host granulation tissue.

A 60 year women presented with a swelling of left breast, since 15 years and lump in right hypochondrium, since 1 year. On clinical examination there was a firm, tense and lobulated swelling of left breast, overlying skin was normal, nipple was displaced antero-medially [Figure - 1] and the liver was palpable 5 cm below the costal margin.


   Radiological Featues of Hydatid disease of Breast:US: Top


The US appearance of the mammary hydatid cyst differs from one patient to another and a variety of sonographic patterns have been previously described [4]. A maturational sequence from simple cyst to multiloculated cystic lesion has been described. Cystic lesion with well-defined wall having recemose interior containing daughter cysts and multiple floating undulating membranes as in our case may be seen. [Figure - 2]a and b The fluid level seen in various intact daughter cysts might be due to the presence of hydatid sand, which comprises a mxture of infolded membranes, fragmented hooklets and debris or secondary to hemorrhage. These findings are similar to the classical findings in hydatid lesions of the liver [5]. The endocyst layer may rupture and become detached from the ectocyst, leading to a free-floating membrane known as the 'water lily' appearance. Cysts may become secondarily infected or traumatized, appearing as echogenically mixed.

CT (Computed Tomography) : CT appearance of hydatid disease is essentially the same as that of US. CT shows a well-defined multilocular low density mass of fluid attenuation. In this case the multi-locular cyst is seen on the anterior aspect of left chest wall extending backwards up to the axilla [Figure - 3] There is associated hydatid cyst in the right lobe of liver.

MRI (Magnetic Resonance Imaginag) : On MRI T1W fast spin-echo imaging mass shows hypointense signals as compared to muscles, surrounded by an isointense capsule [Figure - 5] Lesion appears hyperintense on T2W fast spin-echo images with fat suppression. Lesion appears isointense with peripheral hyperintensity on spoiled gradient recalled acquisition imaging with fat suppression. A ring-shaped capsular enhancement is seen on gadopentate dimeglumin contrast enhanced T1W1 and spoiled gradient recall acquisition study [6].

Mammography: The presence of ring-shaped structures inside a circumscribed lesion in a slowly growing breast mass is suggestive of hydatid cyst [3]. When ring shaped structure is not present, the imaging features of hydatid cyst are nonspecific (Fig.6). When secondary infection exists, the lesion is clinically and mammographycally indistinguishable from breast abscess [7].

Cytology : The cytologic diagnosis of hydatid disease is established by the identification of scolices, hooklets or fragments of laminated membrane. Diagnostic aspiration of the fluid of hydatid cyst for cytologic examination may be hazardous. Leakage from the cyst can lead to a severe anaphylactoid reaction or secondary cyst formation. Therefore, cytologic examination of the aspirated fluid, though invaluable for diagnosis, is not recommended by many authors [8]. In our case no pre operative cytological study was performed and the diagnosis was confirmed operatively.

In our case operative findings revealed cystic lesion with multiple daughter cysts in the left breast extending in to the axillary tail, attached to the underlined pectoral fascia. [Figure - 7] Post operative gross specimen showed a well defined cyst with daughter cysts and membranes, typical of hydatid cyst at any site in the body [Figure 8].

So we conclude that although rare, hydatid disease of the breast should form the part of the differential diagnosis of cystic diseases of the breast especially in endemic country like ours. Awareness of this entity can make the pre operative diagnosis even without cytological examination, which is very helpful in management of the patient.

 
   References Top

1.Oxford textbook of medicine, 3rd edition, vol - 1; 955.   Back to cited text no. 1    
2.M. Beckett Howorth, Echinococcosis of bone, the journal of bone and joint surgery vol-XXVII, No, 3, July-1945; 401-411.   Back to cited text no. 2    
3.Vege A ortega E, Cavada A. Garijo F: Hydatid cyst of the breast: Mammographic findings, AJR 1994; 162:825-826.   Back to cited text no. 3    
4.Noguuera AR, Villavieja L, Martin M, Castillo JJ, Asiron PJ, Gregorio MA: Hydatidosis mamaria: una enfermedad infrecuente. Rev Senol Patol Mam 1988; 1:29-33.   Back to cited text no. 4    
5.Niron EA, Ozer H. Ultrasound appearances of liver hydatid disease. BJR 1981; 54: 335-338.   Back to cited text no. 5  [PUBMED]  
6.Tukel S, Erden I, Ciftci E, Kocak S. Hydatid cyst of the breast: MR imaging findings. AJR Am J Raentgenol. 1997 May; 168 (5): 1386 - 7.   Back to cited text no. 6    
7.Ouedraogo EG. Le kyste hydatique due sein etude de 20 observations, J Gynacol Obstel Biol Reprod 1985; 14: 187-194.   Back to cited text no. 7    
8.Schechner C, Schechner Z, Horowitz Y: Echinococcus cyst of the breast imitating carcinoma. Harefuah 1992; 122: 503-51.  Back to cited text no. 8    

Top
Correspondence Address:
K B Taori
Dept of Radio-Diagnosis, Govt. Medical College, Nagpur
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]

This article has been cited by
1 Preoperative diagnosis of hydatid cyst of the breast: A case report
Alamer, A. and Aldhilan, A. and Makanjuola, D. and Alkushi, A.
Pan African Medical Journal. 2013; 14
[Pubmed]



 

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


    Abstract
    Discussion
    Radiological Fea...
    References
    Article Figures

 Article Access Statistics
    Viewed4221    
    Printed150    
    Emailed3    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 1    

Recommend this journal