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 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 52-53

Filariasis in breast masquerading malignancy


1 National Institute of Pathology (Indian Council of Medical Research), Safdarjang Hospital Campus, New Delhi, India
2 Department of Surgery, Safdarjang Hospital and Vardhman Mahavir Medical College, New Delhi, India

Date of Web Publication7-Apr-2014

Correspondence Address:
Anju Bansal
3126, Sector-D, Pocket-3,Vasant Kunj, New Delhi - 110 070
India
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DOI: 10.4103/1119-0388.130188

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How to cite this article:
Bansal A, Chintamani C, Saxena S. Filariasis in breast masquerading malignancy. Trop J Med Res 2014;17:52-3

How to cite this URL:
Bansal A, Chintamani C, Saxena S. Filariasis in breast masquerading malignancy. Trop J Med Res [serial online] 2014 [cited 2019 Jun 25];17:52-3. Available from: http://www.tjmrjournal.org/text.asp?2014/17/1/52/130188

Sir,

Extranodal filariasis is rare, and breast is an uncommon site for filariasis. The existence of adult filarial worm in breast is very rare. These patients may present with an underlying lump, mimicking malignancy. We describe an unusual case of filariasis in breast in a woman with lump breast, clinically suspicious of a tumor.

A 36-year-old Indian woman, a resident of Delhi, presented to the surgical department of Safdarjang Hospital with a lump in the left breast for 1 month duration. The lump was occasionally painful. There was no history of nipple discharge. There was no history of lactation at the moment, as her child was 6 years old. Past history and family history were noncontributory. Clinical examination revealed a lump in the upper outer quadrant of left breast, measuring 2 × 2 cm, firm, tender, with fixity to overlying skin with peau d'orange but mobile over underlying muscle. There was no axillary lymph node enlargement or any other lymphnodes elsewhere in the body. Examination of the other breast and other systems was normal. Clinical diagnosis of carcinoma breast was made and the patient was further evaluated. Mammography showed BIRADS 3 lesion in the left breast. Fine-needle aspiration from the lump revealed nonspecific acute on chronic inflammatory infiltrate but no malignant cells. The patient was subsequently subjected to lumpectomy. Histological examination of the excised lump demonstrated the presence of adult filarial worm, Wuchereria bancrofti, along with acute on chronic inflammatory tissue reaction to the adult filarial worm [Figure 1] and [Figure 2]. The peripheral smear, however, did not show microfilaria. Diagnosis of filariasis of the breast was made. The patient was subsequently started on diethylcarbamazipine.
Figure 1: Photomicrograph showing adult worm cut in several planes with many microfilariae also seen separately within the necrotic tissue. Surrounding tissue shows dense inflammatory cell infiltrate consisting of polymorphs, lymphocytes, eosinophils, foamy histiocytes, and small multinucleated giant cells (H and E, ×200)

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Figure 2: Photomicrograph showing sections of adult filarial worms containing numerous microfilariae. Surrounding tissue shows sheets of polymorphs, lymphocytes, histiocytes, eosinophils, and plasma cells (H and E, ×400)

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Filariasis is a tropical disease and has been estimated to affect 120 million people throughout the world. [1] Filarial infection is endemic in large areas of India, Africa, and parts of Asia. Lymphatic filariasis in India is caused by W. bancrofti in 90% of cases and Brugia malayi in 10% of cases. Lymphadenitis and lymphangitis are the commoner clinical settings. Female breast is an unusual site for the occurrence of filarial nodule and few cases have been reported. [2] When the female breast is involved, the larvae enter the lymphatic vessels causing lymphangitis, fibrosis, and disruption of lymphatic drainage. Hyperemia in the overlying skin with changes of peau d'orange has also been reported.

Radiologists have described a distinct filarial dance movement and highlight the role of ultrasound as a valuable tool in diagnosing cases of lymphatic filariasis and adult worms. [3] Filarial infection can cause a spectrum of host response, ranging from insignificant changes to marked chronic inflammation and epithelioid granuloma formation, all of which can be seen in fine-needle aspirates. [4],[5] Acute inflammatory changes occur as the parasite dies, which further leads to the formation of a lump. The tissue immune response is variable and intact worms usually provoke only minimal reaction. However, histopathology is confirmatory for diagnosis by finding an inflammatory reaction around the filarial parasites, which may be in varying stages of degeneration.

Appropriate diagnosis was helpful in our patient in obviating a radical treatment, as a suspected case of breast cancer. The case is presented for its rarity, as it was clinically suspicious of carcinoma breast but biopsy revealed the presence of filarial worm. The case underscores the need to maintain suspicion of filarial lesions, especially in patients coming from endemic zones.

 
  References Top

1.Ottesen EA, Hooper PJ, Bradley M, Biswas G. The global programme to eliminate lymphatic filariasis: Health impact after 8 years. In: Institute of Medicine (US) Forum on Microbial Threats. The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies. Washington, DC: National Academies Press, US; 2011. p. A17.  Back to cited text no. 1
    
2.Singh NG, Chatterjee L. Filariasis of the breast, diagnosed by fine needle aspiration cytology. Ann Saudi Med 2009;29:414-5.  Back to cited text no. 2
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3.Patil JA, Patil AD, Ramani SK. Filarial "dance" in breast mass. AJR Am J Roentgenol 2003;181:1157-8.  Back to cited text no. 3
    
4.Partono F. The spectrum of disease in lymphatic filariasis. Ciba Found Symp 1987;127:15-31.  Back to cited text no. 4
[PUBMED]    
5.Rajan TV. Natural course of lymphatic filariasis: Insights from epidemiology, experimental human infections, and clinical observations. Am J Trop Med Hyg 2005;73:995-8.  Back to cited text no. 5
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