Breast - nonmalignant
Parasites
Sparganosis

Author: Jaya Ruth Asirvatham M.B.B.S., M.D. (see Authors page)
Editor: Julie M. Jorns, M.D.

Revised: 28 July 2017, last major update September 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Sparganosis breast

Cite this page: Sparganosis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastsparganosis.html. Accessed November 22nd, 2017.
Definition / general
  • Sparganosis is a parasitic infection caused by spargana, the plercercoid tapeworm larvae of the genus Spirometra
  • Infection occurs by ingestion of impure water that contains larvae, by eating raw amphibians (e.g. frog or snake meat) that serve as intermediate hosts or by applying snake or frog poultices (Wikipedia: Poultice) to wounds
Epidemiology
  • Usually found in East Asia, especially Korea (snake meat is considered an aphrodisiac) but has been reported in Western nations
Sites
  • Most common sites: abdominal wall, urogenital organs, extremities, central nervous system
  • Presents as subcutaneous nodule with vague migrating pain (World J Surg 2011;35:573)
Pathophysiology
  • Infection is caused by the larval stage, which very rarely grow to adults in humans
Clinical features
  • Migrating mass with pain or itching sensation
Laboratory
  • Anti-Sparganum IgG antibody by ELISA
Radiology description
  • Well defined serpinginous hypo-echoic radio-opaque tubular structures are present, usually in subcutaneous fat
  • Can mimic malignancy on mammogram: multiple, lobular, marginated, amorphic and solid masses without calcifications, which are similar to circumscribed breast cancer or fibroadenoma (Korean J Parasitol 2006;44:151)
  • Migration of larvae induces inflammation and increased eosinophil response, which can cause increased FDG uptake
Radiology images

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Mammogram

Ultrasonogram

Radiological imaging

Breast mass

Various images

Case reports
Treatment
  • Surgical excision with removal of the tapeworm is curative
  • Anywhere from 1 - 5 worms may be removed from a mass
Clinical images

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Seen at surgery

Worm in breast nodule at surgery

Gross images

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Segments of sparganum

Extracted worms

Multiple tubular structures

Microscopic (histologic) description
  • The cestode is characterized by a pale myxoid matrix (PAS positive, glycogen rich) with longitudinal smooth muscle fibers and calcareous corpuscles, all surrounded by a noncellular eosinophilic tegument (PAS positive)
  • Thin longitudinal smooth muscle fibers within myxoid matrix of the cestode larva area is the distinguishing feature for organism identification
  • Protoscolex is absent (in contrast to cysticerci)
  • Surrounding tissue may show chronic inflammation, cyst formation, granulomatous inflammation (Breast J 2014;20:92)
Microscopic (histologic) images

Images hosted on other servers:

Male breast: cystic structures

Abdominal skin: H&E

Abdominal skin: H&E, high power

Groin and lung: various images

Abdominal skin: PAS

Additional references