Breast Filariasis

1. Dr. Shameera Begum
1st year Post Graduate
M.D Pathology

2. PATIENT DETAILS
Patient’s Name : Shanthi
Age / Sex : 26 Years / Female
Hospital No. : 16/363894
FNAC No. : 525/16
Date of FNAC : 16/11/2016

3.  26 year old female patient, a resident of Cuddalore, presented
to the surgery OPD with
 H/o swelling in the left breast noticed 1 month ago
 Associated with mild pain
 No h/o fever, weight loss, nipple discharge, axillary
lymphadenopathy
 No h/o swelling of limbs / discoloration of urine

4. On examination:
 Sub areolar mass felt measuring 2 × 1 cm, firm in consistency
with mild tenderness
 Overlying skin and contralateral breast were normal
 Nipple and areola were normal
 Clinically no axillary lymph node was palpable
 Clinical diagnosis: Fibroadenosis / fibrocystic disease
 USG guided FNAC

5. USG

6. USG

7. USG guided fine needle aspiration
 Nature of specimen: FNA of left breast lump
 Greyish white dirty aspirate was obtained
 Haematoxylin and eosin staining was prepared and examined
microscopically

8. Scanner View

9. Low power view

10. High power view

11. High power view

12. High power view Encysted larval forms

13. Impression
 F/S/O Breast nodule with adult worms of Filariasis

14. FILARIASIS
 Lymphatic filariasis is still a public health problem in India
 India alone accounts for 40% of the world disease burden
 9 Indian states (Bihar, Kerala, Uttar Pradesh, Tamil Nadu,
Maharastra, Orissa, Gujarat, West Bengal and Andhra Pradesh )
are endemic for the disease

15. FILARIASIS
 Lymphatic filariasis is caused by nematodes that inhabit the
lymphatic vessels and lymph nodes of humans
 Wuchereria bancrofti (90%)
 Others - Brugia malayi, Brugia timori
 Lower limbs, retroperitoneal tissues, spermatic cord,
epididymis, thyroid and breasts.

16. Breast filariasis
 Filarial involvement of breast is rare with only a few cases
reported in literature.
 Unilateral, soft, non-tender swelling, commonly in upper outer
quadrant
 May be mobile from quadrant to quadrant and mimic
fibroadenoma
 May be associated with enlarged lymph nodes and simulate
breast carcinoma
 Overlying skin can have induration, hyperpigmentation, dilated
veins or peau d’orange appearance

17.  Basu A, Gon S, Bera S, Chakravarti S. Breast Filariasis: A Rare
Cytomorphological Diagnosis. J Pak Med Stud 2013; 3(2):103-105
 Mitra SK, Mishra RK, Verma P. Cytological diagnosis of microfilariae in
filariasis endemic areas of eastern Uttar Pradesh. Journal of Cytology /
Indian Academy of Cytologists. 2009;26(1):11-14. doi:10.4103/0970-
9371.51333.
 Bhattacharjee PK, Ray RP, Halder S. Filariasis of breast: An unusual
presentation. Ann Trop Med Public Health 2012;5:376-8
 S Gole, V Satyanarayana, G Gole. Unusual Cytological Findings In Breast
Aspirates: Case Studies Of Microfilariae With Review Of Literature. The
Internet Journal of Pathology. 2013 Volume 14 Number 1

19. Microfilaria

21. Pathogenesis
 Inflammatory damage to the lymphatics
 Dilatation and thickening of the walls of afferent lymphatics
and sinuses of lymph nodes
 Mechanical blockade, mechanical irritation and release of toxic
substances by adult worms leads to inflammation of
lymphatics and lymph nodes
 Valves become incompetent – chronic lymphoedema
 Death of worm – lymphatic obstruction – elephantiasis
 Lymphangiovarix – chyluria, chylothorax, chylous ascites

22. Clinical features
 Asymptomatic – ‘Endemic normals’
 Acute phase – fever, headache, malaise, fatigue, rashes,
lymphangitis, lympadenitis, epididymo-orchitis, funniculitis
with eosinophilia and microfilaremia
 Chronic phase - lymphadenopathy, lymphedema, hydrocele
and elephantiasis. The lymphatics of the lower extremities
 Lymphatics of lower limbs and genitalia

23.  However, the organisms may be found in any organ of the
body
 Lympho-vascular obstruction extravasation of blood and
release of microfilariae into tissues and tissue fluids

24. Lab diagnosis
 Direct demonstration of microfilaria in peripheral blood
 Nocturnal periodicity
 Earlobes
 Wet mount
 Stained preparation
 DEC provocation test
 Demonstration of adult worm
 In lymph node biopsy
 X –Ray (calcifications)
 USG (Dancing worm / filarial dance sign)

25. • Serological methods
 Fluorescent antibody test
 ELISA
 IHA
 Trop Bio test (ELISA for detection of CFA)
 ICT

26. To conclude……
 In endemic areas, Filariasis should be considered as one of the
differential diagnoses of breast lumps or any superficial
swelling
 FNAC has proved to be a very convenient and effective
diagnostic method in this patient allowing prompt recognition
of disease and institution of specific treatment