Carlos Anselmo LimaI; Aécio Costa CavalcantiI; Márcia Maria Macêdo LimaII; Nestor PivaIII
IDepartment of Oncology, Hospital João Alves, Aracaju, SE, Brazil IIDepartment of Infectious Diseases, Hospital João Alves, Aracaju, SE, Brazil IIILaboratório de Patologia e Citologia, Aracaju, SE, Brazil
ABSTRACT
A case of a pseudoneoplastic lesion of the breast clinically and sonographically suggestive of a fibroadenoma is reported. Excisional biopsy revealed the nodule was an inflammatory process consequent to infection by Schistosoma mansoni.
Key-words: Breast. Schistosomiasis. Pseudoneoplastic lesion. Schistosoma mansoni.
RESUMO
Relata-se um caso de uma lesão pseudoneoplásica da mama clinicamente e ultrasonograficamente sugestiva de um fibroadenoma. A biópsia excisional revelou que o nódulo tratava-se de um processo inflamatório conseqüente à infecção pelo Schistosoma mansoni.
Palavras-chaves: Mama. Esquistossomose. Lesão pseudoneoplásica. Schistosoma mansoni.
Schistosomiasis is an important health problem in the world, mainly in developing countries where it is responsible for more than 200 million infected people. The disease is caused by the schistosome and, although various species are found worldwide, only five cause disease in man: S. mansoni, S. japonicum, S. haematobium, S. mekongi, and S. intercalatum2. In South America, only S. mansoni is known.
There are several clinical presentations of schistosomiasis, defined by manifestations mainly of the gut, urinary tract, portal system, and lungs. Also, ectopic granulomas can occur in every organ. The breast is a very rare site of disease manifestation. Only six cases of this localization were found in the world literature1 3 4 5 6 7. Thus, we report what seems to be the seventh case of a breast lesion caused by S. mansoni, with a clinical and sonographic appearance of fibroadenoma.
CASE REPORT
This 23-year-old woman sought medical attendance because of a painless breast nodule noted six months before admission. Physical examination revealed a non tender, elastic, mobile 2.5 x 2cm mass located between the lower quadrants, near the right nipple. A sonogram revealed a hypoechogenic nodule suggestive of a fibroadenoma. No mammogram was done because of the age of the patient. Excisional biopsy showed a dense fibrous brown mass. Microscopically, two features were outstanding: several granulomas with either viable ova or remnants of ova in the center (Figures 1 and 2) and couples of adult worms inside veins amongst mammary lobules, surrounded by an intense eosinophil-rich inflammatory process (Figure 3). These formed a pseudoneoplastic breast lesion cause by S. mansoni. Since there were viable worms, treatment with oxamniquine was prescribed.
DISCUSSION
The present case occurred in a 23-year-old woman with physical and sonographic findings suggestive of a fibroadenoma. Usually, findings such as this can be monitored and if remain unchanged with time should be left untreated. However, it was decided to perform a surgical excision mainly in view of the patients wishes. Gross appearance was that of a benign lesion and light microscopy enabled the diagnostic confirmation of a mammary nodule caused by S. mansoni. This finding was considered conclusive and so no other diagnostic methods were necessary. Treatment with Oxamniquine was initiated because viable ova were observed. A fecal test revealed no ova soon after treatment. In older women, such a clinical and mammographic appearance would not rule out the possibility of cancer. Thus, either an excision or needle biopsy is necessary for differential diagnosis as well as providing the only form of diagnosing pseudoneoplastic lesions caused by schistosome.
The rarity of the mammary presentation should be emphasized and the six cases reported in the world literature were due to S. japonicum1 5 6 7 and S. haematobium3 4.
To the best of our knowledge, this is the first case to be reported in the world literature, with Schistosoma mansoni as the etiologic agent.
REFERENCES
1. Gorman JD, Champaign JL, Sumida FK, Canavan L. Schistosomiasis involving the breast. Radiology 185:423-424, 1992. [ Links ]
2. Mahmoud AA. Trematodes (Schistosomiasis) and other flukes. In: Mandell GL, Bennet JE, Dolin R (eds) Principles and Practice of Infectious Diseases, 5th Edition, Churchill-Livingstone, Philadelphia, p. 2950-2956, 2000. [ Links ]
3. Nkanza NK. Schistosomal ova in a female breast. Tropical and Geographic Medicine 41:365-367, 1989. [ Links ]
4. Peyromaure M, Antoine M, Gadonneix P, Villet R. La bilharziose: une cause exceptionelle de microcalcifications mammaires. Journal of Gynecology, Obstetrics, Biology and Reproduction 29:790-792, 2000. [ Links ]
5. Sloan BS, Rickman LS, Blan EM, Davis CE. Schistosomiasis masquerading as carcinoma of the breast. Southern Medical Journal 89:345-347, 1996. [ Links ]
6. Varin CR, Eisenberg BL, Ladd W. Mammographic microcalcifications associated with schistosomiasis. Southern Medical Journal 82:1060-1061, 1989. [ Links ]
7. Wu DM. A case of mammary schistosomiasis complicated with breast cancer. Chinese Journal of Parasitologic Diseases 2(suppl): 208, 1984. [ Links ]
Correspondence to
Dr. Carlos Anselmo Lima
Av. Sizino Martins Fontes 84/102, Farolândia
49032-510 Aracaju, SE, Brazil
Telefax: 55 79 243-1713
E-mail: limaca@infonet.com.br
Recebido em 28/7/2003
Aceito em 23/9/2003
