Hydatid Cyst of the Breast: A Review and Update of the Literature

Abstract

Hydatid cyst of the breast is a rare infection of the breast that tends to be reported sporadically in Echinococcus infection endemic areas; nevertheless, because of increasing global travel hydatid cyst of the breast may be encountered in a non-endemic area of the world where clinicians may not be familiar with the manifestation and biological behaviour of the disease. Hydatid cyst of the breast has been reported sporadically in females whose ages have ranged between 16 years and 87 years and these cases only represent 0.27% of all cases of hydatid cyst encountered globally. Hydatid cyst of the breast does present as a lump/mass in the breast which quite often tends to be painless but it could be associated with pain/discomfort. Hydatid cyst of the breast tends to present insidiously and the lump tends to be present for a long time before attention is sought by the patient because it had behaved innocuously and had either been growing slowly with a recent noticeable increase in size over a few months. A history of previous contact with dogs and sheep as well as present or previous residence in an echinococcus endemic area tends to be helpful in alerting the clinician to the possibility of the diagnosis of hydatid cyst. A past history of treatment for echinococcal infection elsewhere in the body would also be helpful in alerting the clinician to the diagnosis of the disease. There tends to be no family history of breast cancer, and no history of previous hormone replacement therapy. The general and systematic examinations of most of the patients tend to be normal unless they have other non-related medical conditions. Clinical examination usually tends to reveal a swelling that tends to be well-circumscribed with clear margin that may be non-tender but at times there may be tenderness associated with the lump. The clinical examination findings tend to be non-specific and would usually mimic fibroadenoma, phyllodes tumour, or intra-cystic carcinoma of the breast. Usually the results of routine haematology and haematology blood tests would tend to be normal unless there is a non-related disease but there could be eosinophilia. Echinococcus hemagglutination test and Elisa test for Echinococcal IgE test would tend to be positive in cases of hydatid cyst of the breast. Various radiology imaging modalities tend to be utilized to assess hydatid cyst of the breast including mammogram, ultrasound scan of the breast, computed tomography (CT) scan of the breast, thorax, and abdomen, magnetic resonance imaging (MRI) scan of breast, thorax, and abdomen. Diagnosis of hydatid cyst of the breast tends to be diagnosed by undertaking fine needle aspiration biopsy of the breast lesion for cytology/histopathology examination or histopathology examination of excised hydatid cysts of the breast. Successful treatment of hydatid cyst of the breast requires complete excision without spillage of the hydatid cyst and additionally to minimise recurrence of disease Albendazole medication tends to be given. When there is spillage of the hydatid cyst or rupture of the hydatid cyst during the process of the excision, a thorough lavage of the operating field and excision of the surrounding tissue to ensure any possible residual daughter cysts are completely removed and utilization of Albendazole medicament would help to minimize or avoid development of recurrence. Because of the possibility of recurrence of disease a period of follow-up assessment with clinical examination and radiology imaging assessment as well as echinococcus hemagglutination tests would be recommended.