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A Mysterious Case of A Breast Lump in A Woman
A Mysterious Case of A Breast Lump in A Woman
Infectious Diseases in Clinical Practice • Volume 26, Number 1, January 2018 www.infectdis.com 47
FIGURE 1. Mammogram image of the breast lump demonstrating FIGURE 3. Photograph from the pathology slides of the breast
rosette-like calcifications in segmental distribution; an arrow biopsy stained with hematoxylin and eosin at 400
points to the abnormality. magnification. This enlarged photograph demonstrates
calcifications corresponding to egg shells consistent with
generally not all symptoms are present. On blood work, there S. japonicum.
will be peripheral eosinophilia. Chronic schistosomiasis is more The egg granulomas and in unusual cases the actual adult
common in people living in endemic areas. Symptoms depend worms of S. japonicum can be found outside the portal venous
on the location or embolization of the eggs. Commonly involved system, where they typically migrate to, and potentially can be lo-
organs are the liver, spleen, genitourinary tract, lungs, and central cated in any of the body's tissues including breast, muscle, pericar-
nervous system, depending on species type.5 dium, esophagus, and kidneys. The main area affected, however, is
Ectopic cutaneous schistosomiasis is an uncommon pre- the brain, although no population-based data are available to indi-
sentation but has been previously reported in the literature.6 Al- cate the actual frequency.8
though the exact mechanism by which ectopic cutaneous Schistosomiasis of the breast is very rare but has appeared in
schistosomiasis occurs is not fully elucidated, one theory suggests the literature previously. A case report from 19969 and another
anastomosis between venous systems may be one way in which from 200510 describe very similar presentations to our patient.
ova or adult worms migrate to ectopic sites.6 Other possibilities In both cases, an asymptomatic female from the Philippines pre-
include the embolization of Schistosoma eggs through arteriove- sented with breast calcifications that on biopsy were found to be
nous shunts opened by portal hypertension in the context of calcified eggs of S. japonicum.
hepatosplenic schistosomiasis.7 The route by which infection of S. japonicum occurs in the
Given that our patient came from the Philippines with no breast should be considered. A case report of four Japanese
outside travel, the only species she could have been exposed women who had S. japonicum in the breast commented that sim-
to was S. japonicum. This is in keeping with identification from ilarly to our patient the eggs were located surrounding the lobules
the pathologist and parasitologist. in the breast, suggesting that they were embolized in the blood-
stream and most likely spread hematogenously.11
CONCLUSIONS
In conclusion, we present an unusual manifestation of an S.
japonicum infection. A breast lump in an elderly woman is not un-
usual. However, the finding in this case is a rare presentation of a
common tropical infectious disease, underscoring the importance
of considering travel and immigration history when investigating
the causes of medical abnormalities.
ACKNOWLEDGMENTS
The authors thank Drs Kinga Kowaleska, Gilbert Bigras,
and Lynora Saxinger for their assistance with this case.
REFERENCES
1. Wilkins PP, Keystone JS. Schistosomiasis serology is valuable and reliable.
Clin Infect Dis. 2012;56:312.
FIGURE 2. Photograph from the pathology slides of the breast
2. Olveda DU, Li Y, Olveda RM, et al. Bilharzia in the Philippines: past,
biopsy stained with hematoxylin and eosin at 200
present, and future. IJID. 2014;18:52–56.
magnification. There are microcalcifications corresponding to egg
shells. Some of the microcalcifications are surrounded by 3. World Health Organization. Atlas of the global distribution of
granulomas. Arrows point to the egg shells. schistosomiasis. 1987. Available at: http://www.who.int/schistosomiasis/