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Siriwardana et al. Journal <strong>of</strong> Medical C<strong>as</strong>e Reports 2011, 5:348<br />

http://www.jmedicalc<strong>as</strong>ereports.com/content/5/1/348<br />

JOURNAL OF MEDICAL<br />

CASE REPORTS<br />

CASE REPORT<br />

Open Access<br />

<strong>Toxopl<strong>as</strong>mosis</strong> <strong>present<strong>in</strong>g</strong> <strong>as</strong> a <strong>swell<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong><br />

<strong>axillary</strong> <strong>tail</strong> <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t and a palpable <strong>axillary</strong><br />

lymph node mimick<strong>in</strong>g malignancy: a c<strong>as</strong>e report<br />

HP Priyantha Siriwardana 1* , Louise Teare 2 , Dia Kamel 3 and E Reggie Inwang 1<br />

Abstract<br />

Introduction: Lymphadenopathy is a common f<strong>in</strong>d<strong>in</strong>g <strong>in</strong> toxopl<strong>as</strong>mosis. A bre<strong>as</strong>t m<strong>as</strong>s due to toxopl<strong>as</strong>mosis is<br />

very rare, and only a few c<strong>as</strong>es have been reported. We present a c<strong>as</strong>e <strong>of</strong> toxopl<strong>as</strong>mosis that presented <strong>as</strong> a<br />

<strong>swell<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> <strong>axillary</strong> <strong>tail</strong> <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t with a palpable <strong>axillary</strong> lymph node which mimicked bre<strong>as</strong>t cancer.<br />

C<strong>as</strong>e presentation: A 45-year-old o<strong>the</strong>rwise healthy Cauc<strong>as</strong>ian woman presented with a lump on <strong>the</strong> lateral<br />

<strong>as</strong>pect <strong>of</strong> her left bre<strong>as</strong>t. Her mo<strong>the</strong>r had bre<strong>as</strong>t cancer that w<strong>as</strong> diagnosed at <strong>the</strong> age <strong>of</strong> 66 years. Dur<strong>in</strong>g an<br />

exam<strong>in</strong>ation, we discovered that our patient had a discrete, firm lump <strong>in</strong> <strong>the</strong> <strong>axillary</strong> <strong>tail</strong> <strong>of</strong> her left bre<strong>as</strong>t and an<br />

enlarged, palpable lymph node <strong>in</strong> her left axilla. Her right bre<strong>as</strong>t and axilla were normal. The cl<strong>in</strong>ical diagnosis w<strong>as</strong><br />

malignancy <strong>in</strong> <strong>the</strong> left bre<strong>as</strong>t. Ultr<strong>as</strong>ound and mammographic exam<strong>in</strong>ations <strong>of</strong> her bre<strong>as</strong>t suggested a pathological<br />

process but were not conclusive. She had targeted f<strong>in</strong>e-needle <strong>as</strong>piration cytology (FNAC) and core biopsy <strong>of</strong> <strong>the</strong><br />

lesions. FNAC w<strong>as</strong> <strong>in</strong>determ<strong>in</strong>ate (C3) but suggested a possibility <strong>of</strong> toxopl<strong>as</strong>mosis. The core biopsy w<strong>as</strong> not<br />

suggestive <strong>of</strong> malignancy but showed granulomatous <strong>in</strong>flammation. She had a wide local excision <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t<br />

lump and an <strong>axillary</strong> lymph node biopsy. Histopathology and immunohistochemical studies excluded carc<strong>in</strong>oma or<br />

lymphoma but suggested <strong>the</strong> possibility <strong>of</strong> <strong>in</strong>tramammary and <strong>axillary</strong> toxopl<strong>as</strong>mic lymphadenopathy. The results<br />

<strong>of</strong> Toxopl<strong>as</strong>ma gondii IgM and IgG serology tests were positive, support<strong>in</strong>g a diagnosis <strong>of</strong> toxopl<strong>as</strong>mosis.<br />

Conclusions: <strong>Toxopl<strong>as</strong>mosis</strong> rarely presents <strong>as</strong> a pseudotumor <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t. FNAC and histology are valuable tools<br />

for a diagnosis <strong>of</strong> toxopl<strong>as</strong>mosis, and serology is an important adjunct for confirmation.<br />

Introduction<br />

Lymphadenopathy is <strong>the</strong> most frequent cl<strong>in</strong>ical manifestation<br />

<strong>of</strong> acute <strong>in</strong>fection with Toxopl<strong>as</strong>ma gondii <strong>in</strong> <strong>the</strong><br />

immunocompetent <strong>in</strong>dividual. Toxopl<strong>as</strong>ma lymphadenitis<br />

typically <strong>in</strong>volves a lymph node <strong>in</strong> <strong>the</strong> head and neck<br />

region, presents with or without systemic symptoms or<br />

extranodal dise<strong>as</strong>e, and runs a benign cl<strong>in</strong>ical course<br />

[1,2]. A bre<strong>as</strong>t m<strong>as</strong>s due to toxopl<strong>as</strong>mosis is rare, and<br />

only a few c<strong>as</strong>es have been reported [3-5]. We present a<br />

c<strong>as</strong>e <strong>of</strong> toxopl<strong>as</strong>mosis that presented <strong>as</strong> an <strong>axillary</strong> <strong>tail</strong><br />

(bre<strong>as</strong>t) m<strong>as</strong>s and a palpable <strong>axillary</strong> lymph node which<br />

mimicked bre<strong>as</strong>t cancer.<br />

* Correspondence: hppsir@hotmail.com<br />

1 Department <strong>of</strong> Surgery, Broomfield Hospital, Court Road, Chelmsford, Essex,<br />

CM1 7ET, UK<br />

Full list <strong>of</strong> author <strong>in</strong>formation is available at <strong>the</strong> end <strong>of</strong> <strong>the</strong> article<br />

C<strong>as</strong>e presentation<br />

A 45-year-old Cauc<strong>as</strong>ian woman with a left <strong>axillary</strong> <strong>tail</strong><br />

(bre<strong>as</strong>t) m<strong>as</strong>s and left-sided chest pa<strong>in</strong> presented to <strong>the</strong><br />

bre<strong>as</strong>t cl<strong>in</strong>ic. She also compla<strong>in</strong>ed that her left bre<strong>as</strong>t<br />

had changed <strong>in</strong> appearance. She had a positive family<br />

history: her mo<strong>the</strong>r had bre<strong>as</strong>t cancer and her fa<strong>the</strong>r<br />

had lung cancer. There w<strong>as</strong> no nipple discharge, fever,<br />

or history <strong>of</strong> trauma to her bre<strong>as</strong>t. She had two children<br />

and had undergone a hysterectomy for benign dise<strong>as</strong>e<br />

two years before. Both <strong>of</strong> her ovaries were reta<strong>in</strong>ed.<br />

There w<strong>as</strong> no o<strong>the</strong>r significant medical history or<br />

known allergies. Her general health w<strong>as</strong> good.<br />

The result <strong>of</strong> a general exam<strong>in</strong>ation w<strong>as</strong> normal.<br />

There were two palpable nodules, one <strong>in</strong> <strong>the</strong> upper<br />

outer quadrant <strong>in</strong> <strong>the</strong> <strong>axillary</strong> <strong>tail</strong> <strong>of</strong> her left bre<strong>as</strong>t (20<br />

mm) and <strong>the</strong> o<strong>the</strong>r <strong>in</strong> <strong>the</strong> left axilla (10 mm). The result<br />

<strong>of</strong> an exam<strong>in</strong>ation <strong>of</strong> her right bre<strong>as</strong>t and axilla, abdomen,<br />

and o<strong>the</strong>r systems w<strong>as</strong> normal. The most likely<br />

© 2011 Siriwardana et al; licensee BioMed Central Ltd. This is an Open Access article distributed under <strong>the</strong> terms <strong>of</strong> <strong>the</strong> Creative<br />

Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and<br />

reproduction <strong>in</strong> any medium, provided <strong>the</strong> orig<strong>in</strong>al work is properly cited.


Siriwardana et al. Journal <strong>of</strong> Medical C<strong>as</strong>e Reports 2011, 5:348<br />

http://www.jmedicalc<strong>as</strong>ereports.com/content/5/1/348<br />

Page 2 <strong>of</strong> 4<br />

diagnosis w<strong>as</strong> considered to be a malignant lesion <strong>in</strong> <strong>the</strong><br />

left bre<strong>as</strong>t with met<strong>as</strong>tatic <strong>in</strong>volvement <strong>of</strong> an <strong>axillary</strong><br />

lymph node.<br />

She underwent ultr<strong>as</strong>ound and mammographic exam<strong>in</strong>ations<br />

<strong>of</strong> her bre<strong>as</strong>ts. The mammogram showed a<br />

smooth-outl<strong>in</strong>ed, s<strong>of</strong>t-density lesion <strong>in</strong> her left bre<strong>as</strong>t<br />

with no microcalcifications and a few small lymph<br />

nodes <strong>in</strong> her left <strong>axillary</strong> <strong>tail</strong>. Ultr<strong>as</strong>ound revealed that<br />

<strong>the</strong> palpable lump <strong>in</strong> <strong>the</strong> lateral part <strong>of</strong> her left bre<strong>as</strong>t<br />

w<strong>as</strong> a 2 cm solid lesion with reduced echogenicity. The<br />

o<strong>the</strong>r nodule, <strong>in</strong> <strong>the</strong> upper part <strong>of</strong> <strong>the</strong> left axilla, w<strong>as</strong><br />

also solid (1 cm) and suggestive <strong>of</strong> a lymph node (M4<br />

U4; that is, suspicious abnormality accord<strong>in</strong>g to <strong>the</strong><br />

Bre<strong>as</strong>t Imag<strong>in</strong>g Report<strong>in</strong>g and Data System, or BIRADS).<br />

The radiological appearance w<strong>as</strong> highly suggestive <strong>of</strong> a<br />

lymphoma. Then she underwent targeted f<strong>in</strong>e-needle<br />

<strong>as</strong>piration cytology (FNAC) <strong>of</strong> <strong>the</strong> <strong>axillary</strong> lesion and<br />

core needle biopsy <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t lesion. The FNAC w<strong>as</strong><br />

<strong>in</strong>determ<strong>in</strong>ate (C3) but showed numerous monotonous<br />

lymphocytes <strong>in</strong> a background conta<strong>in</strong><strong>in</strong>g lymphogranular<br />

bodies suggestive <strong>of</strong> granulomatous <strong>in</strong>flammation<br />

such <strong>as</strong> toxopl<strong>as</strong>mosis. There were no malignant cells.<br />

The core biopsy showed a small aggregate <strong>of</strong> epi<strong>the</strong>leoid<br />

histiocytes and mult<strong>in</strong>uclear giant cells <strong>in</strong> keep<strong>in</strong>g with<br />

granulomatous <strong>in</strong>flammation. There w<strong>as</strong> no evidence <strong>of</strong><br />

a malignancy.<br />

Her c<strong>as</strong>e w<strong>as</strong> discussed at <strong>the</strong> multidiscipl<strong>in</strong>ary meet<strong>in</strong>g,<br />

and <strong>the</strong> team recommended a wide local excision <strong>of</strong><br />

<strong>the</strong> bre<strong>as</strong>t lesion with palpable <strong>axillary</strong> lymph node<br />

biopsy. The results <strong>of</strong> a histological exam<strong>in</strong>ation (Figures<br />

1 and 2) <strong>of</strong> <strong>the</strong> resected specimens <strong>of</strong> bre<strong>as</strong>t and<br />

<strong>axillary</strong> lesions were suggestive <strong>of</strong> an <strong>in</strong>tramammary and<br />

<strong>axillary</strong> lymph node m<strong>as</strong>s with marked follicular<br />

Figure 1 A microscopic exam<strong>in</strong>ation <strong>of</strong> <strong>the</strong> specimens <strong>of</strong><br />

bre<strong>as</strong>t (<strong>axillary</strong> <strong>tail</strong>) lump and <strong>axillary</strong> lymph node shows<br />

marked follicular hyperpl<strong>as</strong>ia with prom<strong>in</strong>ent small granulom<strong>as</strong><br />

composed almost entirely <strong>of</strong> epi<strong>the</strong>lioid cells.<br />

Figure 2 A microscopic exam<strong>in</strong>ation <strong>of</strong> <strong>the</strong> specimens <strong>of</strong><br />

bre<strong>as</strong>t (<strong>axillary</strong> <strong>tail</strong>) lump and <strong>axillary</strong> lymph node shows<br />

marked follicular hyperpl<strong>as</strong>ia with prom<strong>in</strong>ent small granulom<strong>as</strong><br />

composed almost entirely <strong>of</strong> epi<strong>the</strong>lioid cells.<br />

hyperpl<strong>as</strong>ia. In addition, <strong>the</strong>re were prom<strong>in</strong>ent microgranulom<strong>as</strong><br />

composed almost entirely <strong>of</strong> epi<strong>the</strong>lioid cells<br />

located with<strong>in</strong> <strong>the</strong> hyperpl<strong>as</strong>tic follicles. Immunohistochemical<br />

sta<strong>in</strong><strong>in</strong>g showed an anatomical distribution <strong>of</strong><br />

B- and T-cell markers. A Ziehl-Neelsen sta<strong>in</strong> for acidf<strong>as</strong>t<br />

bacilli and Grocott and PAS+D (periodic acid-Schiff<br />

after di<strong>as</strong>t<strong>as</strong>e digestion) sta<strong>in</strong>s for fungi were negative.<br />

The histological appearances were similar to those<br />

described <strong>in</strong> toxopl<strong>as</strong>mosis, but <strong>the</strong> differential diagnoses<br />

<strong>in</strong>cluded o<strong>the</strong>r <strong>in</strong>fectious dise<strong>as</strong>es and lymphadenopathy-<strong>as</strong>sociated<br />

autoimmune or immunodeficiency<br />

disorders. There were no features to suggest lymphoma<br />

or o<strong>the</strong>r malignancy. Histological material w<strong>as</strong> referred<br />

for a second op<strong>in</strong>ion that confirmed <strong>the</strong> above. The T.<br />

gondii serology tests detected Toxopl<strong>as</strong>ma IgG and IgM<br />

antibodies suggestive <strong>of</strong> an acute or recently acquired<br />

Toxopl<strong>as</strong>ma <strong>in</strong>fection. Our patient w<strong>as</strong> treated symptomatically<br />

<strong>as</strong> <strong>the</strong>re were no <strong>in</strong>dications to treat her toxoplamosis<br />

with antiprotozoal drugs. She h<strong>as</strong> been well for<br />

<strong>the</strong> l<strong>as</strong>t two years s<strong>in</strong>ce <strong>the</strong> diagnosis.<br />

Discussion<br />

<strong>Toxopl<strong>as</strong>mosis</strong> is caused by <strong>in</strong>fection with T. gondii, an<br />

obligate <strong>in</strong>tracellular par<strong>as</strong>itic protozoa. The <strong>in</strong>fection<br />

produces a wide range <strong>of</strong> cl<strong>in</strong>ical syndromes <strong>in</strong> humans,<br />

land and sea mammals, and various bird species. <strong>Toxopl<strong>as</strong>mosis</strong><br />

p<strong>as</strong>ses from animals to humans, ma<strong>in</strong>ly via<br />

<strong>in</strong>fected cat feces. T. gondii <strong>in</strong>fects a large proportion <strong>of</strong><br />

<strong>the</strong> world’s population but rarely causes cl<strong>in</strong>ically significant<br />

dise<strong>as</strong>e. Although <strong>in</strong>fection does not normally<br />

spread from person to person except through pregnancy,<br />

toxopl<strong>as</strong>mosis can, <strong>in</strong> rare <strong>in</strong>stances, contam<strong>in</strong>ate<br />

blood transfusions and organs donated for transplantation.<br />

In most immunocompetent <strong>in</strong>dividuals, primary or


Siriwardana et al. Journal <strong>of</strong> Medical C<strong>as</strong>e Reports 2011, 5:348<br />

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Page 3 <strong>of</strong> 4<br />

chronic (latent) T. gondii <strong>in</strong>fection is <strong>as</strong>ymptomatic <strong>in</strong><br />

80% to 90% <strong>of</strong> healthy hosts [1].<br />

Lymphadenopathy is <strong>the</strong> most frequent manifestation<br />

<strong>of</strong> acute acquired <strong>in</strong>fection <strong>in</strong> immunocompetent <strong>in</strong>dividuals.<br />

The typical presentation is a pa<strong>in</strong>less firm lymphadenopathy<br />

conf<strong>in</strong>ed to one cha<strong>in</strong> <strong>of</strong> nodes, most<br />

commonly cervical. O<strong>the</strong>r physical manifestations<br />

<strong>in</strong>clude low-grade fever, hepatosplenomegaly, and sk<strong>in</strong><br />

r<strong>as</strong>h. Our patient did not have any such manifestations.<br />

Toxopl<strong>as</strong>ma lymphadenitis most frequently <strong>in</strong>volves a<br />

solitary lymph node <strong>in</strong> <strong>the</strong> head and neck region, presents<br />

with or without systemic symptoms or extranodal<br />

dise<strong>as</strong>e and runs a benign cl<strong>in</strong>ical course. However, serious<br />

extranodal dise<strong>as</strong>e does occur <strong>in</strong> a small percentage<br />

<strong>of</strong> patients and <strong>in</strong>cludes myocarditis, pneumonitis, encephalitis,<br />

chorioret<strong>in</strong>itis, and transmission <strong>of</strong> <strong>in</strong>fection to<br />

<strong>the</strong> fetus [2]. Individuals at risk for severe or life-threaten<strong>in</strong>g<br />

toxopl<strong>as</strong>mosis <strong>in</strong>clude fetuses, newborns, and<br />

immunologically impaired patients. In immunodeficient<br />

<strong>in</strong>dividuals, toxopl<strong>as</strong>mosis most <strong>of</strong>ten occurs <strong>in</strong> those<br />

with defects <strong>of</strong> T cell-mediated immunity, such <strong>as</strong> those<br />

with hematologic malignancies, bone marrow and solid<br />

organ transplants, or AIDS.<br />

Both histological features <strong>of</strong> biopsy specimens or cytology<br />

<strong>of</strong> needle <strong>as</strong>pirate [6] and serological tests are important<br />

<strong>in</strong> <strong>the</strong> diagnosis <strong>of</strong> toxopl<strong>as</strong>mosis and it w<strong>as</strong> not<br />

until both were available <strong>in</strong> this c<strong>as</strong>e that a diagnosis <strong>of</strong><br />

toxopl<strong>as</strong>mosis w<strong>as</strong> made. The histological features have<br />

been well described [2] but sometimes can be confused<br />

with o<strong>the</strong>r disorders, particularly sarcoidosis, very early<br />

tuberculosis, cat-scratch dise<strong>as</strong>e [7], and more benign<br />

forms <strong>of</strong> Hodgk<strong>in</strong> dise<strong>as</strong>e, all <strong>of</strong> which may have a cl<strong>in</strong>ical<br />

presentation similar to that <strong>of</strong> toxopl<strong>as</strong>mosis [2]. Immunohistochemistry<br />

can help identify T. gondii with<strong>in</strong><br />

pathology specimens. Molecular polymer<strong>as</strong>e cha<strong>in</strong> reaction<br />

techniques have high specificity but low sensitivity<br />

<strong>in</strong> lymph node specimens, and <strong>the</strong> role <strong>of</strong> molecular biology<br />

<strong>in</strong> <strong>the</strong> diagnosis <strong>of</strong> toxopl<strong>as</strong>mosis h<strong>as</strong> been reported<br />

[8]. Serology tests are an important adjunct but, on <strong>the</strong>ir<br />

own, must be <strong>in</strong>terpreted with some care, <strong>as</strong> positive<br />

tests with low titers are common, presumably because <strong>of</strong><br />

latent <strong>in</strong>fection. In our c<strong>as</strong>e, however, serology test<strong>in</strong>g<br />

w<strong>as</strong> strongly positive, support<strong>in</strong>g <strong>the</strong> histological f<strong>in</strong>d<strong>in</strong>gs.<br />

In an o<strong>the</strong>rwise healthy person who is not pregnant, <strong>as</strong><br />

<strong>in</strong> this c<strong>as</strong>e, treatment is not <strong>in</strong>dicated. Symptoms will<br />

usually resolve with<strong>in</strong> a few weeks [2]. If toxopl<strong>as</strong>mosis is<br />

acquired <strong>in</strong> pregnancy, transplacental <strong>in</strong>fection may lead<br />

to severe dise<strong>as</strong>e <strong>in</strong> <strong>the</strong> fetus. Spiramyc<strong>in</strong> may reduce <strong>the</strong><br />

risk <strong>of</strong> transmission <strong>of</strong> maternal <strong>in</strong>fection to <strong>the</strong> fetus.<br />

For people who have weakened immune systems, antiprotozoal<br />

drugs such <strong>as</strong> a comb<strong>in</strong>ation <strong>of</strong> pyrimetham<strong>in</strong>e<br />

and sulfadiaz<strong>in</strong>e are given for several weeks [2].<br />

Conclusions<br />

<strong>Toxopl<strong>as</strong>mosis</strong> rarely presents <strong>as</strong> a m<strong>as</strong>s <strong>in</strong> <strong>the</strong> <strong>axillary</strong><br />

<strong>tail</strong> <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t and may be considered <strong>as</strong> a differential<br />

diagnosis <strong>in</strong> patients <strong>present<strong>in</strong>g</strong> with <strong>axillary</strong> lymphadenopathy.<br />

FNAC and histology are valuable tools<br />

for a diagnosis <strong>of</strong> toxopl<strong>as</strong>mosis and serology is an<br />

important adjunct for confirmation. If <strong>the</strong> FNAC or<br />

core biopsy suggests <strong>the</strong> possibility <strong>of</strong> toxopl<strong>as</strong>mosis,<br />

serological <strong>in</strong>vestigations can confirm <strong>the</strong> diagnosis<br />

and may help avoid fur<strong>the</strong>r <strong>in</strong>v<strong>as</strong>ive procedures and<br />

anxiety. Adult patients who are immunocompetent, are<br />

not pregnant and do not have <strong>in</strong>volvement <strong>of</strong> a vital<br />

organ may be managed conservatively without antiprotozoal<br />

drugs.<br />

Consent<br />

Written <strong>in</strong>formed consent w<strong>as</strong> obta<strong>in</strong>ed from <strong>the</strong> patient<br />

for publication <strong>of</strong> this c<strong>as</strong>e report and any accompany<strong>in</strong>g<br />

images. A copy <strong>of</strong> <strong>the</strong> written consent is available<br />

for review by <strong>the</strong> Editor-<strong>in</strong>-Chief <strong>of</strong> this journal.<br />

Abbreviation<br />

FNAC: f<strong>in</strong>e-needle <strong>as</strong>piration cytology.<br />

Author de<strong>tail</strong>s<br />

1 Department <strong>of</strong> Surgery, Broomfield Hospital, Court Road, Chelmsford, Essex,<br />

CM1 7ET, UK.<br />

2 Department <strong>of</strong> Microbiology, Broomfield Hospital, Court Road,<br />

Chelmsford, Essex, CM1 7ET, UK.<br />

3 Department <strong>of</strong> Pathology, Broomfield<br />

Hospital, Court Road, Chelmsford, Essex, CM1 7ET, UK.<br />

Authors’ contributions<br />

HPPS, <strong>the</strong> pr<strong>in</strong>cipal author, contributed to design<strong>in</strong>g <strong>the</strong> report and writ<strong>in</strong>g<br />

<strong>the</strong> <strong>in</strong>troduction, c<strong>as</strong>e presentation, and discussion sections. LT and DK<br />

contributed to <strong>the</strong> discussion. ERI collected <strong>the</strong> data, obta<strong>in</strong>ed consent from<br />

<strong>the</strong> patient, supervised <strong>the</strong> project, and undertook <strong>the</strong> f<strong>in</strong>al revision before<br />

submission. All authors read and approved <strong>the</strong> f<strong>in</strong>al manuscript.<br />

Compet<strong>in</strong>g <strong>in</strong>terests<br />

The authors declare that <strong>the</strong>y have no compet<strong>in</strong>g <strong>in</strong>terests.<br />

Received: 9 November 2010 Accepted: 4 August 2011<br />

Published: 4 August 2011<br />

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<strong>Toxopl<strong>as</strong>mosis</strong>; par<strong>as</strong>ite life cycle. In Pathology and Immunology. Edited<br />

by: Hammond DM, Long PL. Baltimore: University Park Press; 1973:342-410.<br />

2. McCabe RE, Rem<strong>in</strong>gton JS: Toxopl<strong>as</strong>ma gondii. In Pr<strong>in</strong>ciples and Practice <strong>of</strong><br />

Infectious Dise<strong>as</strong>es. Part III.. 2 edition. Edited by: Mandell GL, Dougl<strong>as</strong> RG,<br />

Bennett JE. New York: John Wiley; 1985:154-1556.<br />

3. Kouba K, Lobovská A, Kudrmann J, L<strong>as</strong>ovská J: Pseudotumours <strong>of</strong><br />

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Cite this article <strong>as</strong>: Siriwardana et al.: <strong>Toxopl<strong>as</strong>mosis</strong> <strong>present<strong>in</strong>g</strong> <strong>as</strong> a<br />

<strong>swell<strong>in</strong>g</strong> <strong>in</strong> <strong>the</strong> <strong>axillary</strong> <strong>tail</strong> <strong>of</strong> <strong>the</strong> bre<strong>as</strong>t and a palpable <strong>axillary</strong> lymph<br />

node mimick<strong>in</strong>g malignancy: a c<strong>as</strong>e report. Journal <strong>of</strong> Medical C<strong>as</strong>e<br />

Reports 2011 5:348.<br />

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