No abstract

A healthy 64-year-old Filipina presented with microcalcifications on an initial screening mammogram (Figs. 1 and 2). Her physical examination was without palpable mass and otherwise negative. Biopsy was recommended and she underwent core needle breast biopsy with stereotactic guidance and vacuum assistance. Using an 11-gauge needle, four specimens were obtained; additional images confirmed removal of the microcalcifications.Pathologic findings were multiple, old schistosome eggs in a background of benign breast tissue (Fig. 3). The eggs were uniformly oval and measured less than 100 µ m; neither opercula nor viable miracidia were present, prominent lateral or terminal spines were not visualized, and the eggs were not birefringent when viewed with planepolarized light. These findings exclude the possibility of either a Paragonimus species or Schistosoma mansoni and Schistosoma hematobium . Based on the morphologic findings, Schistosoma mekongi , endemic to the Mekong River in Southeast Asia, is a diagnostic possibility, but Schistosoma japonicum , endemic to the Philippines, is more likely; these eggs are morphologically identical to those present in colonic biopsies from patients with documented S. japonicum infections. We are confident therefore that the microcalcifications seen on mammography were secondary to a remote S. japonicum infection the patient contracted in her native Philippines. The patient was referred to an infectious disease specialist for evaluation.