|Year : 2021 | Volume
| Issue : 1 | Page : 84-86
Microfilaria in breast masquerading as a breast lump: A report of two cases
Abhay Vilas Deshmukh, Vitaladevuni Balasubramanyam Shivkumar, Vihanka Devchand Vaidya, Nitin M Gangane
Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
|Date of Submission||30-Nov-2019|
|Date of Decision||24-Jan-2020|
|Date of Acceptance||11-Mar-2020|
|Date of Web Publication||22-Jan-2021|
Vitaladevuni Balasubramanyam Shivkumar
Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha - 442 102, Maharashtra
Source of Support: None, Conflict of Interest: None
Filariasis is one of the common health problems in India. Extranodal filariasis occurs rarely, and the breast is one of the uncommon sites. Here, we report two cases of breast filariasis in the middle-aged females presented with a painless lump in the left breast. These cases were clinically mistaken as a malignancy. Cytology smears showed numerous microfilariae in both coiled and uncoiled forms along with benign ductal cells. Thus, the diagnoses of filariasis breast probably arising from intramammary lymph nodes were made in both cases. The patients were treated conservatively, and the recovery was uneventful. Thus, fine-needle aspiration cytology played an important role to avoid unnecessary surgical intervention in these patients.
Keywords: Breast lump, carcinoma breast, fine-needle aspiration cytology, microfilaria
|How to cite this article:|
Deshmukh AV, Shivkumar VB, Vaidya VD, Gangane NM. Microfilaria in breast masquerading as a breast lump: A report of two cases. Med J DY Patil Vidyapeeth 2021;14:84-6
|How to cite this URL:|
Deshmukh AV, Shivkumar VB, Vaidya VD, Gangane NM. Microfilaria in breast masquerading as a breast lump: A report of two cases. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Feb 26];14:84-6. Available from: https://www.mjdrdypv.org/text.asp?2021/14/1/84/307679
| Introduction|| |
Filariasis is one of the common health problems in endemic countries such as India. It is more prevalent in river banks and coastal areas of India., The filarial infections in India are most commonly caused by Wuchereria bancrofti and Brugia malayi. The most commonly affected sites include lymph nodes and lymphatics. Microfilaria (MF) have also been isolated from various other unusual sites such as spermatic cord, epididymis, thyroid, lung, hydrocele fluid, effusion fluids (pleural, ascitic, and peritoneal), nipple discharge, and cervicovaginal smears.,, Breast is also one of the uncommon sites for filarial lesions.,, Few cases have been reported in the literature till date.,,, Here, we report two cases of filariasis of the breast which were mistaken clinically as carcinoma breast. Fine-needle aspiration cytology (FNAC) played a pivotal role in the line of the management.
| Case Report|| |
The first case was a 46-year-old female presented to the surgery outpatient department with a lump in the left breast for 3 months. Local examination revealed the presence of 3 cm × 2 cm lump in the left breast upper-outer quadrant. It was nontender, mobile, and hard in consistency. The second case, a 48-year-old female, had a similar clinical presentation. Local examination revealed a lump 1 cm × 1 cm nodule in the upper-inner quadrant, nontender, mobile, and firm in consistency. There was the presence of nipple retraction in the first case. There were no skin changes (peau d'orange) in both cases. The examination in other breast was normal, and there was no axillary lymphadenopathy in ipsilateral as well as contralateral side in both cases. Both the patients were average built, and routine blood investigations were within the normal limits.
FNAC was done in both cases to find out the nature of the lesion. It was performed from the lump using a 24G needle and 10 mL syringe. The aspirate was fluidy in both cases. Both dry- and wet-fixed smears were prepared. Smears were stained with Papanicolaou and May–Grunwald–Giemsa stains. Giemsa-stained smears were poorly cellular and showed the presence of abundant MF in both coiled and uncoiled forms [Figure 1] and [Figure 2]. The MF was sheathed with elongated terminal nuclei and a central caudal space at the posterior end [Figure 2]. There was the presence of few benign duct epithelial cells admixed with occasional inflammatory cells comprising neutrophils, eosinophils, and lymphocytes [Figure 1] and [Figure 3]. No epithelioid cells were seen. No malignant cells were seen in both cases. A diagnosis of MF in the breast probably arising from intramammary lymph node was done on the basis of cytomorphological features in both cases. The patients were treated with Diethylcarbamazine (DEC) for 3 weeks after which the lump was subsided in both cases.
|Figure 1: Cytology of aspirate from the breast lump showing the presence of microfilariae in the background of occasional inflammatory cells and red blood cells. (Giemsa, ×400)|
Click here to view
|Figure 2: Cytology smears showing sheathed microfilariae with elongated terminal nuclei and a central caudal space at the posterior end in the background of few lymphocytes and red blood cells. (Giemsa, ×1000)|
Click here to view
|Figure 3: Cytology smears showing microfilariae along with few benign ductal cells along with few lymphocytes and red blood cells. (Giemsa, ×1000)|
Click here to view
| Discussion|| |
Filariasis is an important public health problem in tropical countries such as Africa and Asia. It is an endemic disease in India and commonly caused by W. bancrofti and B. malayi. Ninety percent of cases in India are caused by these two species. MF of the breast presenting as a malignancy is an uncommon entity, and very few cases have been described in the literature.,,
Filarial breast lump usually presents with firm and nodular lump which often mimics neoplastic breast lesions on examination. The lump was commonly observed in the upper-outer quadrant of the breast. However, in our cases, one patient had a lump in the upper outer, whereas another had a lump in the upper-inner quadrant. The pathogenesis of filarial nodule involves lymphangitis. The larvae enter the breast lymphatics initially which causes lymphangitis and fibrosis, leading to lymphatic obstruction. Sometimes, filarial nodule can attach to overlying skin, leading to hyperemia and peau d'orange giving wrong clinical interpretation as carcinoma breast., Kaur et al. described a young female patient with skin induration over the breast along with axillary lymphadenopathy mimicking inflammatory carcinoma. Das et al. also described similar case of filariasis of the breast which was clinically mistaken for inflammatory carcinoma in a 55-year-old patient.
FNAC is a simple, comparatively less invasive, well established, cost-effective, and widely available investigation to differentiate between neoplastic and non-neoplastic causes of the breast lump. Cytology smears usually show the presence of benign duct epithelial cells, inflammatory cells consisting of eosinophils, neutrophils, and histiocytes and MF worm.,,
In our both cases, considering the age and clinical examination, the patients were suspected to have malignancy. One of the patients had nipple retraction which was again in favor of carcinoma breast. Both patients were treated conservatively with DEC and lump disappeared on the treatment.
| Conclusion|| |
MF breast is a rare entity and in middle-aged females, it usually mimics a malignant breast lesion. FNAC plays an important role in the diagnosis of filarial breast lump which helps to avoid unnecessary surgical interventions. MF breast should always be considered as a differential diagnosis for painless breast lump in endemic countries such as India.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kaur R, Philip KJ, Masih K, Kapoor R, Johnny C. Filariasis of the breast mimicking inflammatory carcinoma. Lab Med 2009;40:683-5.
Pal S, Bose K. Microfilaria in fine needle aspiration cytology of breast lump: An unusual finding. J Health Spec 2015;3:235-7. [Full text]
Mitra SK, Mishra RK, Verma P. Cytological diagnosis of microfilariae in filariasis endemic areas of Eastern Uttar Pradesh. J Cytol 2009;26:11-4.
] [Full text]
Jha A, Shrestha R, Aryal G, Pant AD, Adhikari RC, Sayami G. Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic. Nepal Med Coll J 2008;10:108-14.
Chowdhary M, Langer S, Aggarwal M, Agarwal C. Microfilaria in thyroid gland nodule. Indian J Pathol Microbiol 2008;51:94-6.
] [Full text]
Sangwan S, Singh SP. Filariasis of the breast. Med J Armed Forces India 2015;71:S240-1.
Khan R, Harris SH, Maheshwari V. Filarial breast mouse. J Coll Physicians Surg Pak 2011;21:513.
Das S, Lal H, Dey M, Mohindra N. Bilateral breast filariasis mimicking inflammatory breast carcinoma. BMJ Case Rep 2017:bcr2017221845.
[Figure 1], [Figure 2], [Figure 3]