Breast cysticercosis manifestation is usually uncommon and only a few cases have been reported in the literature. Thismanifests in the form of signs and symptoms which normally do not point towards the diagnosis. The radiological modalitiesalways narrow down the gap between the complaints and the diagnosis. We present a case with cysticercus cysts in breastparenchyma as well as in both pectoral muscles which was suspected on ultrasonography (USG) and diagnosed on MagneticResonance Imaging (MRI). The patient responded to the medical treatment conservatively thus avoiding excisional biopsy.Follow up and repeat MRI has confirmed the cure of the complaints as well as the disease

A, Bhardwaj

BB, Sharma

RK, Mishra

S, Jilowa

S, Kumar

Y, Singh

English

Atharva Scientific Publications (E-Jounals)

Sharma et al                                                                 Cysticercosis of Breast 
Vol 1 / Issue 1 / Jan-Mar 2015                                                            Indian J Case Reports / 1 
Case Report 
Radiological diagnosis of Cysticercosis of Breast - An unusual presentation   
Sharma BB
1
, Jilowa S
1
, Kumar S
2
, Bhardwaj A
1
, Singh Y
1
, Mishra RK
1
 
From 1Department of Radio diagnosis & 2Surgery, Post Graduate Institute of Medical Education and Research & Dr. Ram 
Manohar Lohia hospital, New Delhi, India 
Correspondence to:  Dr Bharat Bhushan Sharma, B-32, Nivedita Kunj, Sector 10, R K Puram, New Delhi – 110022. E mail: 
bbhushan986@gmail.com Tel No +91 11 26182700 
Received: 28 November 2014 Initial Review: 28 December 2014 Accepted: 31 December 2014  Publishedonline:06 January 2015 
ABSTRACT 
Breast cysticercosis manifestation is usually uncommon and only a few cases have been reported in the literature. This 
manifests in the form of signs and symptoms which normally do not point towards the diagnosis. The radiological modalities 
always narrow down the gap between the complaints and the diagnosis. We present a case with cysticercus cysts in breast 
parenchyma as well as in both pectoral muscles which was suspected on ultrasonography (USG) and diagnosed on Magnetic 
Resonance Imaging (MRI). The patient responded to the medical treatment conservatively thus avoiding excisional biopsy. 
Follow up and repeat MRI has confirmed the cure of the complaints as well as the disease. 
Key words: Cysticercosis, Magnetic Resonance Imaging (MRI), Radiological modalities, Ultrasonography 
ysticercosis is a parasitic infection caused by 
cysticercus cellulosae which can affect any organ 
or tissue of the body. The common sites 
encountered are skeletal muscles, subcutaneous 
tissues, brain and eye. Occasionally the heart, lung, liver, 
kidney and bone may also be involved. The patients with 
breast cysticercosis usually present with a painful or 
painless lump in the breast. It can affect all the age groups 
and cases have been reported in patients as young as 16 yrs 
to as old as 63 yrs. USG and MRI, being non-invasive and 
radiation free modalities, have a promising role in 
diagnosis and follow up of these patients. This may also 
help avoiding unnecessary surgical interventions.  
CASE REPORT   
A 29 year old female presented with complaints of pain in 
the right breast and anterior chest wall of two years 
duration. The pain used to increase on movement of right 
shoulder and right arm. There was no associated history of 
fever. Biochemical tests and parameters were normal. The 
clinical examination of bilateral breasts revealed an ill-
defined, non-tender (2x2cm) palpable lump in outer upper 
quadrant of right breast with normal nipple-areolar 
complex. There was mild tenderness in the anterior 
axillary fold on right side. Left breast did not reveal any 
abnormality and was normal on clinical examination. 
There was no other complaint suggestive of any other 
focus in musculoskeltal regions in the body. 
Mammography of right breast did not reveal any 
definitive lesion. USG of the breasts revealed two small 
cystic lesions in fibroglandular tissue of right breast 
measuring 8 mm each. A hypoechoic cystic lesion 
measuring 2x1.6 cm was also seen in left pectoralis major 
muscle with central echogenic focus. The right pectoralis 
major muscle was reported as normal. Provisional 
diagnosis of cysticercosis of breast was made and for 
further evaluation and confirmation of diagnosis, MRI 
chest region was done. MRI revealed two well defined 
round to oval cystic lesions measuring 7.8 mm each 
hypointense on T1W and hyperintense on T2W in right 
breast parenchyma (Fig 1 a, b and c).  
C 
Sharma et al                                                                 Cysticercosis of Breast 
Vol 1 / Issue 1 / Jan-Mar 2015                                                            Indian J Case Reports / 2 
 
Figure 1 a, b and c – Non-contrast MRI Axial sections of both breasts. (a) T1W image shows hypointense cystic lesion 
(arrow) in deep pectoralis muscle of the right side and bulky left pectoral muscle. (b) T2W image at the same location 
shows hyperintense lesion (horizontal arrow). (c) T2W image shows twin hyperintense parenchymal lesions in right 
breast (arrow). 
     
Figure 2 - Contrast enhanced MRI breast. (a) T2W Axial section of left breast shows hyperintense lesion (arrow) with 
hypointense rim seen in pectoralis major muscle. (b) T2W Sagittal section shows same lesion with well defined margins 
(arrow) 
 
Figure 3 a, b and c – Contrast enhanced MR breast. (a) T1W Sagittal section of the right breast shows intramuscular 
cystic lesion with enhancing wall and scolex (arrow) resembling cyst with dot appearance. (b) T1W Axial section the 
same intramuscular lesion (arrow) with enhancing bulky pectoralis muscle. (c) Post treatment T1W Contrast enhanced 
axial section has shown regression of right breast parenchymal and muscular lesions (arrow). 
Another well-defined cystic lesion of similar intensity 
measuring 0.95 mm was noted in right pectoralis major 
muscle showing post-contrast enhancement of mural 
nodule (Fig 2 a, b and 3 a, b). Left pectoralis major was 
bulky and had a cystic lesion with surrounding edema and 
heterogenous enhancement (Fig 2 a, b). Possibility of 
chronic inflammatory granulomatous lesions like 
cysticercosis was considered in view of multiple lesions in 
the right breast and in both pectoral muscles, in a patient 
living in countries like India. MRI brain was done to look 
Sharma et al                                                                 Cysticercosis of Breast 
Vol 1 / Issue 1 / Jan-Mar 2015                                                            Indian J Case Reports / 3 
for any concomitant cerebral lesions and was found to be 
normal.  
Patient was treated with oral albendazole (15 
mg/kg/day in 2 divided doses) for four weeks along with 
analgesics. Patient responded to the treatment and had 
symptomatic relief. There was also disappearance of the 
right breast lump during the course of albendazole.  The 
patient was closely followed up and follow up MRI was 
done after three months of therapy. MRI showed two small 
crumpled barely visible lesions in upper outer quadrant of 
right breast. Lesions in both pectoral muscles were 
completely resolved (Fig 3 c). 
DISCUSSION 
Cysticercosis is caused by encysted larvae of pork 
tapeworm called Taenia solium and it is endemic in 
countries like Maxico, Eastern Europe, Africa, South East 
Asia, and Latin America. Cysticercosis is common in rural 
areas of developing countries. The organism is transmitted 
to humans by ingestion of eggs from contaminated water 
or food or through autoinfection [1]. The eggs hatch in 
small intestine, release oncospheres which penetrate the 
bowel mucosa and finally blood stream to reach to various 
other organs of the body to develop into cysticercus 
cellulosae. 
Cysticercus may remain viable for years without 
inducing host inflammatory response. When the larvae 
dies, it induces vigorous granulomatous inflammatory 
response with resultant clinical manifestations depending 
on the organ involved [2,3]. The most frequent sites of 
involvement are muscles of the upper arm, chest wall, eye, 
abdominal wall, neck followed by tongue, face and breast. 
Involvement of breast substance by cysticercosis is not 
uncommon and it should be included in the differential 
diagnosis for a lump in the breast like in our case. Clinical 
symptoms of the cysticercosis depend on the number and 
site of involvement as well as the extent of associated 
inflammation. Clinical diagnosis of breast cysticercosis is 
often difficult and lesions may mimic as fibroadenoma [4]. 
Cysticercosis should be considered in a patient living in 
endemic area if a cystic lesion is found in or near the 
pectoral muscle and should be included in differential 
diagnosis of lump in the breast [2].  
The diagnosis has usually been made by 
needle/excision biopsy and is correlated with 
histopathological examination in earlier reports [5]. USG 
and MRI can play a vital role in characterization of these 
lesions, being non-invasive modality with no risk of 
radiation. USG is the best modality of imaging to 
differentiate between cystic and solid lesions. This can 
also highlight the internal echoes of the lesions with distal 
enhancement or shadowing [6-7]. Intramuscular cysts are 
oriented in the direction of muscular fibres. For 
localization of small lesions not detectable by both 
mammography and ultrasonography, MRI can be an 
invaluable tool.  
MRI is helpful in depicting number, location and stages 
of parasites. Cysticercosis on MRI is seen as cystic lesion 
that appears hyperintense on T2W and hypointense on 
T1W images. Scolex appears as a tiny hypointense speck 
within the hyperintense cyst. Peripheral rim enhancement 
of cyst wall is also seen on contrast images as in our case. 
MRI may show a high intensity, 2-4 mm mural nodule, 
depicting the scolex in the interior of parenchymal cysts. 
These are pathognomonic of cysticercosis on gadolinium 
enhanced images which corresponds to the active 
parenchymal form of the cyst [8]. Susceptibility weighted 
imaging has been used in detecting calcifications in 
cysticercus cysts in brain and also in breast [9].  
European College of Radiology, 2013 on 
neurocysticercosis considered cystic lesions showing 
scolex on CT/MRI as absolute criteria and spontaneous 
resolution of small ring enhancing lesions with 
albendazole as major criteria for the diagnosis. Our case 
showed spontaneous resolution on medical therapy. MRI 
can play a role in follow up of these cases after medical 
treatment, thus avoiding unnecessary biopsy and excision 
of lumps.  
CONCLUSION 
Breast Cysticercosis is uncommon lesion but not rare. 
Cysticercosis should be included in the differential 
diagnosis of breast lumps in patients especially living in 
endemic countries and presenting with multiple cystic 
lesions with scolex, particularly associated with lesions in 
pectoral muscles. USG is the initial modality to know 
about the consistency and morphology of the lesions. MRI 
has a promising role in the diagnosis and follow-up of 
these cases, thus avoiding unnecessary excision biopsy and 
intervention.  
Sharma et al                                                                 Cysticercosis of Breast 
Vol 1 / Issue 1 / Jan-Mar 2015                                                            Indian J Case Reports / 4 
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How to cite this article: Sharma BB, Jilowa S, Kumar S, 
Bhardwaj A, Singh Y, Mishra RK. Radiological diagnosis of 
Cysticercosis of Breast - An unusual presentation. Indian J 
Case Reports. 2015;1(1):1-4. 
Conflict of interest: None stated, Funding: Nil 
 


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