We report a case of 59-year-old woman with a painful left breast mass, compatible with types II-III hydatid cyst. Lesion was evaluated with mammography, ultrasound, computed tomography, and magnetic resonance imaging modalities. Magnetic resonance imaging had important diagnostic role with demonstrating characteristic features of the lesion and had capability of showing complications. Surgery also confirmed the diagnosis of a hydatid cyst.
Hydatid cyst of the breast is very rare. Patients usually present to the hospital with a palpable and painless lump in the breast. It is challenging to differentiate it from other tumoral lesions of the breast. Only few reports of breast hydatid cyst are published and majority of the reported cases have been diagnosed postoperatively. We report a case with breast hydatid cyst with MR imaging findings. The report has been approved by the Institutional Review Board of the institution with patient informed consent.
A 59-year-old female patient referred with palpable, longstanding (over 10 years) mass in the periphery of left breast that was remarkable with pain for the last 8 months. There was no history of breast trauma, hormone replacement therapy, or family history of malignancy. Physical examination revealed a palpable nonfixed mass on the anterior chest wall, peripherally located in the left breast with regular borders. The nipple, areola, and overlying skin were normal and no palpable lymph node in both axilla. Routine laboratory tests were in normal ranges.
Mammography examination with craniocaudal (CC) and medial lateral oblique (MLO) projections revealed dense mass, situated peripherally at 9 o’clock, with a regular, lobulated contour in the left breast, with no identifiable micro- and macrocalcifications (Figure
59-year-old woman with left breast mass. CC mammogram shows dense mass with sharply defined, lobulated contours, located at the inner part of the left breast.
At sonography, lesion was compatible with a semisolid mass and had a smooth bordered, moderately thickened wall, with a dimension of 4.5
Gray-scale sonogram. Smooth bordered semisolid mass with internally scattered, mostly circumferentially oriented anechoic multiple cyst, creating rosette appearance and accompanying echogenic material filled the intercystic spaces (hydatid sand).
Because the sonographic findings suggested hydatid cyst, thoracoabdominal CT was performed for checking probable simultaneous lesions. CT exam showed no abnormal mass in performed body parts, without left breast lesion. The breast lesion was heterogeneous hypodense with a smooth thick wall and septations, internally, had a density of 35 HU (Figure
Axial contrast-enhanced thorax CT image. Hypodense, well-defined mass with capsular wall and internal septae, situated at the inner part of the left breast. The lesion shows capsular enhancement.
(a) Axial T1- and (b) T2-weighted MR images show that left breast mass with well-defined borders has multiple cystic loculations creating “rosette” pattern. Capsular wall and internal septae of the lesion are isointense on T1-weighted image and hypointense on T2-weighted image; marginally contrast enhancement seen on fat-saturated contrast enhanced T1-weighted image (c).
STIR sequence image demonstrates hypointense capsule and detached internal membrane with perilesional fluid accumulation eccentrically, revealing focal rupture.
The surgical specimen showed characteristic daughter cysts of hydatid disease.
The imaging modalities for diagnosis of breast hydatid disease are mammography, ultrasound, and MRI. Mammography shows a nonspecific, homogeneous, smooth, circumscribed lesion [
The ultrasound findings vary according to the degree of maturation and the complications [
In our case, sonography revealed well-demarcated mass with lobulated contours that contain round-shaped cysts scattered circumferentially and septae within, giving an appearance of “water lily” sign and “wheel-spoke” pattern of the disease, consistent with a types II-III hydatid cyst.
MRI findings can be helpful but not specific. The findings of cystic lesion with capsular enhancement are suggestive of hydatid cyst. The capsular enhancement is more typical with secondary infection. Diagnosis is frequently delayed because no specific signs are found at the time of examination, and they instead mimic other pathologies [
Edema or acute inflammation caused by compression of or allergic reaction in soft tissue adjacent to the cyst is uncommon but may be seen [
The differential diagnosis based on mammography would include cyst, fibroadenoma, phyllodes tumour and, rarely circumscribed carcinoma. Vega et al. noted that the presence of ring shaped structures and interseptal bands in the slowly growing breast mass should suggest a hydatid cyst [
The authors declare that there is no conflict of interests regarding the publication of this paper.