Ann Surg Treat Res.  2014 Dec;87(6):336-339. 10.4174/astr.2014.87.6.336.

Axillary sparganosis which was misunderstood lymph node metastasis during neoadjuvant chemotheraphy in a breast cancer patient

• Lee EK
• Yoo YB

• KMID: 2167091
• DOI: http://doi.org/10.4174/astr.2014.87.6.336

Abstract

Sparganosis of the breast is an uncommon disease, but should be considered in the differential diagnosis of unusual and suspicious breast masses. A history of ingesting contaminated water and direct ingestion of snakes and frogs may help in differential diagnosis of the mass. Complete surgical removal is the treatment of choice and provides a definite diagnosis. We report a case of multiple axillary lymph node sparganosis. It was first considered as an axillary metastasis of breast cancer because a newly axillary mass appeared in follow-up radiologic study after neoadjuvant chemotherapy. We performed curative breast cancer surgery and sparganosis was confirmed by extracting the worm during axillary dissection.

Keyword

Sparganosis; Axilla; Breast carcinoma

MeSH Terms

Axilla
Breast
Breast Neoplasms*
Diagnosis
Diagnosis, Differential
Drug Therapy
Eating
Follow-Up Studies
Humans
Lymph Nodes*
Neoplasm Metastasis*
Snakes
Sparganosis*
Water Pollution
Water Pollution

Figure

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  Fig. 1 Initial breast imaging. (A) Breast MRI shows 5-cm-sized regional enhancement at right upper breast with negative finding in right axilla. (B) 18F-fluoro-2-D-glucose positron PET-CT shows hypermetabolic lesions in right upper breast without significant hypermetabolism at right axilla.

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  Fig. 2 Follow-up breast imaging after 3 cycles of neoadjuvant chemotherapy. (A) Breast MRI shows interval decrease of nonmass-like enhancement in right breast and newly appeared enlarged lymph nodes at right axilla. (B) 18F-fluoro-2-D-glucose PET-CT shows a decreased size and activity of right breast cancer and newly developed hypermetabolic lymph nodes at right axilla.

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  Fig. 3 Gross appearance of whitish flat sparganum extracted from the axillary lymph nodes by surgeon in the operating room.

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  Fig. 4 Histologic findings showed body of the sparganum embedded in axillary lymph node and granulomatous inflammation with serpiginous necrosis and ghosty eggs (H&E, ×40).

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  Fig. 5 Follow-up breast imaging after 1 year of operation. Hypermetabolism, left neck level II lymph node. Inflammatory lesion, more likely Otherwise, no significant abnormal hypermetabolic lesion suggesting malignancy.

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