Unveiling Primary Breast Hydatid Cysts: A Rare Parasitic Infection Case Study
- A 51-year-old Iranian woman from Kerman province visited the clinic with a painless lump in her left breast.
- The patient had three pregnancies, with two live births and one intrauterine fetal demise.
- The left breast had a well-defined, firm, non-tender mass measuring about 4×4 cm in the upper outer quadrant.
Case Overview: Breast Cyst Diagnosis
A 51-year-old Iranian woman from Kerman province visited the clinic with a painless lump in her left breast. She noticed this mass around one year ago, and it had not changed in size. She had no symptoms like breast pain, nipple discharge, or skin changes, nor did she connect the lump’s characteristics to her menstrual cycle.
Medical History
The patient had three pregnancies, with two live births and one intrauterine fetal demise. She breastfed her two children and has no family history of breast cancer or other hereditary conditions. Her vital signs were normal, and she reported no systemic issues like fever or fatigue.
Physical Examination
On examination, the patient appeared healthy. There were no signs of anemia or lymphadenopathy. The left breast had a well-defined, firm, non-tender mass measuring about 4×4 cm in the upper outer quadrant. The mass was mobile and showed no skin changes. Palpable lymph nodes were found in the left axilla, but these were also mobile and firm.
Imaging Studies
Ultrasonography and mammography of both breasts and axillary regions were performed. The ultrasound indicated a 4.5×4 cm, smooth, oval anechoic lesion in the left breast, likely a benign simple cyst (BI-RADS 3). No features indicated malignancy.
Differential Diagnoses
The possible diagnoses for the cyst included:
- Simple breast cyst: Common due to its appearance.
- Complicated breast cyst: Possible but less likely without internal echoes.
- Fibroadenoma: Could appear cystic but is usually solid.
- Phyllodes tumor: Rare due to size.
- Intracystic papilloma: Considered due to recurrence.
- Breast abscess: Unlikely because of the absence of inflammation.
Recurrence and Treatment
After six months, the cyst refilled, now measuring 5×5 cm. The clinical team decided to surgically excise the cyst. Preoperative tests showed eosinophilia. An ELISA test confirmed the presence of Echinococcus granulosus antibodies, indicating a possible hydatid cyst.
Surgical Findings
During surgery, the cyst was found well-encapsulated. It measured 5.5×5.0×4.5 cm, filled with clear fluid. Microscopic examination confirmed the diagnosis of a hydatid cyst. PAS staining indicated the characteristic laminated membrane.
Additional Testing
Immunoblot assays supported the diagnosis further. Special stains, such as Ziehl-Neelsen and Grocott’s methenamine silver, revealed features typical of Echinococcus granulosus.
Assessment for Dissemination
The patient underwent comprehensive tests to rule out other cysts. These included:
- Clinical examination for other masses.
- CT scans of the chest, abdomen, and pelvis.
- Abdominal ultrasound.
No additional hydatid cysts were found, confirming an isolated breast hydatid cyst.
Post-Surgical Care
Patient education focused on hygiene practices to prevent reinfection. She was advised on washing produce, avoiding undercooked meat, and maintaining hand hygiene.
Multidisciplinary Approach
Given the rarity of primary breast hydatid cysts, a team involving infectious disease specialists, surgeons, and radiologists managed the patient’s care. This collaboration ensured comprehensive treatment and monitoring.