significantly older than skeletal osteosarcoma-patients.

Mammography identifies a dense lesion with obvious

calcifications, and on bone scan the lesion is usually

easily seen because of high uptake of technetium 99

diphosphonate. The definitive diagnosis is obtained

histologically with the use of specific immunohisto-

chemical markers. Surgery remains the primary treat-

ment and the role of adjuvant chemo-or radiotherapy

remains unclear, mainly because of the rarity of the

disease and data about it. Complete resection of the

primary tumor, with microscopically free margins,

achieved by mastectomy or breast conserving surgery,

is of pivotal importance in the treatment of primary

breast sarcomas. However, despite proper surgical

treatment, the 5-year survival rate has been reported

to be only 38%.

Cutaneous Schistosomiasis Mimicking Paget’s Diseaseof the Breast

Lesley Pennell, RGN, BSc, Ian Seddon, FRCPath, and Ihab Anwar, MS, FRCS,FACS

The Breast Unit, Essex County Hospital, Colchester, Essex, UK

A 32-year-old English woman presented to the

breast clinic with a skin lesion on left breast. She

was well and denied any other medical symptoms.

Topical eczema treatments and antibiotics had failed

to resolve the problem. There was a history of travel

to South America 1 year ago.

On examination there was an isolated eczematous

looking breast lesion over the superior edge of the are-

ola complex with a 2 cm ridge of surrounding breast

tissue and some infected hair follicles; there was no

other clinical findings. She was well with no previous

breast symptoms or family history of breast or ovarian

cancer. Ultrasound of the breast and punch biopsy of

the lesion were performed. The ultrasound scan was

normal.

Histological examination of the skin biopsy con-

tained granulomata with foreign body giant cell and

calcified and noncalcified parasites within these

(Figs 1–3). The morphology of the appearance was

most supportive of schistosomes. Further characteriza-

tion as to the subtype was not possible.

Following diagnosis, laboratory investigations taken

to investigate white cell differential, renal and liver

function were normal. Serology for schistosomiasis

and strongyloides were negative and stools and urine

examinations did not reveal any schistosomal ova.

Our case was referred for treatment to a Tropical

Medical Centre and was treated with praziquantel.

The rarity of this presentation should be made

known and although infestation cannot be acquired in

the UK, international travel and immigration has the

potential to increase the numbers of infested patients

Figure 1. Skin and granulomatous inflammation in the subcutis

with multiple S. haematobium ova.

Address correspondence and reprint requests to: Ihab Anwar, MS,

FRCS, FACS, The Breast Unit, Essex County Hospital, Lexden Road, Col-

chester, Essex C03 3NB, UK, or e-mail: anwar.ihab@colchesterhospital.

nhs.uk.

DOI: 10.1111/j.1524-4741.2010.01030.x

ª 2011 Wiley Periodicals, Inc., 1075-122X/11The Breast Journal, Volume 17 Number 1, 2011 99–100

Cutaneous Schistosomiasis Mimicking Paget’s • 99

worldwide. Breast specialists should be aware of this

presentation when evaluating patients with unusualskin lesions who have traveled in areas where schisto-

somiasis is endemic.

Breast Carcinoma with Co-existent Microfilariasisand Filarial Lymphadenitis Diagnosed on Cytology

Sanjay Gupta, MD, Shyama Jain, MD and Pushpa Sodhani, MD

Division of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR) NOIDA,Uttar Pradesh and Maulana Azad Medical College, New Delhi, India

A50 year-old woman presented with a lump in

upper outer quadrant of right breast of 3 months

duration. On clinical examination, the lump measured

5 · 3 cm, was firm, irregular, and nontender. It was

fixed to the underlying tissues and skin overlying the

mass revealed peau-de-orange. There was no nipple

discharge. A solitary lymph node was palpable in right

axilla measuring 2 cm in diameter. It was firm, non-

tender, and mobile. The contralateral breast and both

axillae were unremarkable.

Fine needle aspiration (FNA) was performed from

the breast lump as well as axillary lymph node. The

smears were air dried and processed for Giemsa

staining. The smears from breast lump revealed tumor

cells present singly as well as in loosely cohesive

clusters, at places arranged in papillaroid and acinar

fashion (Fig. 1).The cells had moderate amount of

cytoplasm and displayed nuclear pleomorphism,

hyperchromasia, and prominent nucleoli. At places, the

tumor cells displayed apcorine differentiation (Fig. 2).

Foci of necrosis were present. Single bipolar bare nuclei

were absent. In addition, an occasional epithelioid cell

granuloma was seen along with mixed inflammatory

infiltrate and sprinkling of eosinophils (Fig. 3). On care-

ful screening of the smear, a few coiled and uncoiled

microfilariae were identified (Figs. 1 and 2). They were

labeled as larvae of Wuchereria bancrofti by the pres-

ence of hyaline sheath and somatic nuclei extending

from head to tail, the tail tip being free of nuclei.

Aspirate smears from axillary lymph node showed

reactive lymphoid hyperplasia. A solitary microfilaria

was identified in one of the smears (Fig. 4). There was

Figure 2. Schistosome ova and benign microcalcifications. Figure 3. Schistosome ovum with probable terminal spine indicat-

ing S. haematobium.

Address correspondence and reprint requests to: Dr Sanjay Gupta, Sci-

entist E, Division of Cytopathology, Institute of Cytology and Preventive

Oncology (ICMR), I-7, Sector 39, NOIDA 201301, Uttar Pradesh, India, or

e-mail: sanjaydr17@hotmail.com

DOI: 10.1111/j.1524-4741.2010.01037.x

ª 2010 Wiley Periodicals, Inc., 1075-122X/10The Breast Journal, Volume 17 Number 1, 2011 100–102

100 • gupta et al.