Downloaded from www.ajronline.org by 190.167.212.148 on 11/02/15 from IP address 190.167.212.148. Copyright ARRS. For personal use only; all rights reserved

51

Case

Mammographic Cynthia

A. Britton,1

Jules

Appearance Sumkin,2

Manju

Math,3

of Loiasis and

Scott

Few, if any, reports have been published on the mammographic appearance of parasitic disease within the breast, although the plain film findings of three parasitic diseases, dracunculiasis, cysticercosis, and loiasis, have been described [1-3]. Infection with any of these parasites can produce subcutaneous calcifications that are visible on plain films or mammograms. We describe a case of loiasis in the breast

Williams4

that had clustered larvae.

3 4

Department

of Radiology,

Department Department

of Pathology, Magee-Women’s of Surgery, Magee-Women’s

AJR 159:51-52,

Magee-Women’s

July 1992 0361-803X/92/1591-0051

in upper

P1., 3705

Hospital, Forbes Ave. and Halket St., Pittsburgh,

outer

Fifth Ave.,

PA 15213.

Hospital, Forbes Ave. and Halket St., Pittsburgh, PA 15213. Hospital, Forbes Ave. and Halket St., Pittsburgh, PA 15213. C American

Roentgen

appearance associated

of indeterminate with the Loa ba

A 29-year-old woman had had a painful mass in the upper quadrant of her right breast for 2 weeks. She had no discharge

Received November 22, 1991 ; accepted after revision January 9, 1992. Department of Radiology, University of Pittsburgh Medical Center, One Children’s A. Britton. 1

the mammographic microcalcifications

Case Report

Fig. 1.-Loiasis mimicking malignant calcifications on mammography. A, Mediolateral mammogram shows calcified larvae within a suspicious lesion (arrow) B, Magnified mammogram shows serpiginous calcifications (arrow) of Lea lea larvae. C, Radiograph confirms inclusion of calcified larvae (arrow) within biopsy specimen.

2

Report

Ray Society

quadrant

Pittsburgh,

outer from

of right breast.

PA 1 5213.

Address

reprint

requests

to C.

52

BRITTON

the nipple,

fever, or erythema.

As a Peace Corps

volunteer

in Gabon, or African masses in her Her family history was

West Africa, in 1985, she became infected with the eye worm, and had a history of multiple subcutaneous extremities

Downloaded from www.ajronline.org by 190.167.212.148 on 11/02/15 from IP address 190.167.212.148. Copyright ARRS. For personal use only; all rights reserved

significant

breast

associated for

the

with

death

of

the

infection.

a maternal

L. Ice,

grandmother

at

age

34

of

cancer.

A mammogram showed serpiginous calcifications within a suspicious lesion in the upper outer quadrant of the right breast (Fig. 1A). A magnified view showed that the calcifications resembled neither typical

benign

sional

biopsy

and exclude

nor

malignant

was performed

carcinoma.

breast

calcifications

to confirm

(Fig.

the presence

The radiograph

confirmed the presence of the calcified (Fig. 1 C). Histologic examination showed reaction accompanying the worms.

1 B). An

exci-

of L. Ice larvae

of the biopsy

specimen

larvae within the specimen a giant-cell granulomatous

Discussion Loiasis is a tropical disease caused by the worm Larvae enter the patient via the bite of the mango reproduce

in the

subcutaneous

tissue,

usually

in the

L. boa. fly and

is completed

when

the infected

AJR:159,

July 1992

The mature larvae die and calcify within the subcutaneous tissue. Their serpiginous, filamentous appearance is suggestive of a parasitic infection and is unlike that of benign or malignant breast calcifications. They are usually accompanied by painful areas of intense inflammation called Calabar swellings,

named

for

a West

African

town

in which

loiasis

is

endemic. This is seen most commonly in the extremitiesthe breast mass in this patient is an unusual example of a Calabar swelling located centrally within the body. When accompanied with an intense inflammatory reaction, the combination of a mass with microcalcifications on mammography may cause confusion in excluding a malignant tumor, as in this patient. The diagnosis of loiasis is supported by a history of travel to an endemic area such as West Africa, the presence of immature worms or micnofilariae in the blood, eosinophilia, and a history of Calabar swellings or subconjunctival worms. REFERENCES

extrem-

itiesand in the subconjunctival tissues of the eye. The life cycle of the worm

ET AL.

human

host

isagain bittenby the mango fly,and the microfilaria produced by the larvae become infectivewithinthe fly.

1 . Reeder

NM.

Tropical

diseases

of the

soft

tissues.

Semin

Roentgenol

1973;8:47-71 2. Johnstone RDC. Loiasis. Lancet 1947:1:250-252 3. Aesnick D, Niwayama G. Diagnosis of bone and joint

Philadelphia:

Saunders,

1988:2735-2736

disorders,

2nd ed.