Breast - nonmalignant
Parasites
Cysticercosis

Author: Jaya Ruth Asirvatham M.B.B.S., M.D. (see Authors page)
Editor: Julie M. Jorns, M.D.

Revised: 28 July 2017, last major update June 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Cysticercosis breast

Cite this page: Cysticercosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastcysticercosis.html. Accessed October 20th, 2017.
Definition / general
  • Cysticercosis is caused by the larval form of Taenia solium (cysticercus cellulose) after ingestion of food contaminated with its eggs
Epidemiology
  • Prevalent in Mexico, Africa, Southeast Asia, Eastern Europe, South America
  • Common in rural areas of developing countries
Sites
  • Common sites are the brain, skeletal muscles, heart and eye
  • Cysticercosis of the breast is rare
  • 8 cases were identified by FNAC over a 15 year period in India (Acta Cytol 1996;40:653)
Pathophysiology
Etiology
  • Acquired by ingestion of tapeworm eggs transferred via the fecal oral route
Diagrams / tables

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Diagram

Clinical features
  • Cysticercosis of the breast may present as a cystic mass that may be freely mobile
Radiology description
  • Radiology may reveal a cyst with or without mural nodule
  • Calcification may be present
Radiology images

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Cysts

Mammogram, tubular structure

Case reports
Treatment
  • Albendazole, praziquantel
Gross description
  • Cysts range from a few millimeters to 1 - 2 cm occasionally
  • Viable cysts are translucent, through which a single scolex may be visible (2 - 3 mm nodule)
  • As the cyst begins to degenerate, the fluid becomes dense and opaque
  • In the later stages only a calcified nodule may be present
Gross images

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Breast cyst (AFIP fig 31)



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Breast: tubular, worm-like structure

Oral cavity, well circumscribed nodule

Microscopic (histologic) description
  • Multilayered cyst wall with a single invaginated scolex, which contains a rostellum, 4 suckers and 22 - 23 hooklets
  • A host inflammatory reaction is usually not present if the larva is viable
  • Cysticerci may remain viable for years
  • Colloidal stage: first stage of involution of cysticerci; transparent vesicular fluid is replaced by a turbid, viscous fluid and the scolex shows signs of hyaline degeneration
  • Granular stage: cysticercus is no longer viable; cyst wall thickens and the scolex is transformed into coarse mineralized granules
  • Finally, a granulomatous reaction develops characterized by histiocytes, epitheloid cells and foreign body giant cells, leading to fibrosis of the supporting stroma and calcification of the parasitic debris
  • Hooklets may persist for a long time
Microscopic (histologic) images

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CNS

Eyelid



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Cyst wall enclosing structure

Cyst composed of 3 layers

Foreign body giant cell reaction

Larva enclosed in a thin fibrous cyst wall


Eye: cyst wall

Eye

Eye: hooklet of cysticercus

Cytology description
  • Fibrillary material with interspersed small nuclei may be seen
  • Parts of parasite may be identifiable (Acta Cytol 1996;40:653)
  • The background usually consists of a mixed inflammatory infiltrate (Acta Cytol 1989;33:659)
  • Granulomas may be seen
Cytology images

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Breast: larval fragment

Bladder: wall of cysticercus



Other sites:

Wall of cysticercus

Epithelioid cell granulomas

Various images

Inflammatory infiltrate

Fibrillary stroma

Positive stains