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Title : A 53-year old female w/ right breast mass
Date : December 23, 2008
Contributed by

Jeong A Lee,M.D., Hae Suk Cheong, M.D. Samsung Medical Center, Seoul, Korea

Patient History
Age/Sex 53/Female
Chief complaint Rt breast palpable mass
Present illness

Four months before visiting a hospital, a two-palpable masses of right breast was detected.

Past medical history

Two year earlier, she had diagnosed tuberculous lymphadenitis on right neck area. She took a anti-tuberculous medication for 9-months.

Physical examination

A two small mobile firm mass with normal overlying skin on right upper quadrant area of right breast.

Initial laboratory findings

CBC 5050>12.7<189K (segmented neutrophil 65%,eosinophil 12%) AST/ALT 15/12 BUN/Cr 16.3/0.67

Radiologic findings

Ultrasonography revealed two flat heterogenous low-echoic masses located intramuscular layer. They are measured 1.1cm x 0.6cm and 1.1cm x 1.7cm in each (Figure 1).

Hospital course

Fine needle aspiration biopsy was performed on the breast masses, which showed histiocytes and multinucleated giant cells with necrotic material. As a result, the masses were initially diagnosed as tuberculosis. Three months later , 1.1cm x 1.7cm mass increased in volume. The enlarged multiloculated mass was measured 4cm x 8cm and internal material was moving.

Figure 1

Question - ID Case of the Week ( December 23, 2008 )
Q. What is your diagnosis?
Correct Answer



# Sparganum

The larval form of the diphyllobothriid tapeworms of the genus dipyllobothrium and
spirometra. Fish-eating mammals and man are the final hosts.

Sparganosis has been reported in South America, Japan, China, and other parts of Asia in association with traditional use of frog-or snake meat poultices.

-Mode of infection
Eating various kinds of animal fleshes including snakes and frogs drinking untreated water.

-Clinical presentation
Typically involves local inflammation at the site of invasion (skin and eye are the most common sites for poultice application, but Spaganum have the ability to migrate to any part of the human body. There is local lymphotic and eosinophilic inflammation surrounding the parasites.

A confirmatory diagnosis should be estabilished by extracting the worm responsible or by examing surgical pathology specimens. Antibody against sparanum detected by ELISA is also helpful to diagnosis sparganosis.

- Treatment
Surgical extraction is only way to cure.


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