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Breast Filariasis

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Breast Filariasis

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Breast Filariasis

  1. 1. Dr. Shameera Begum 1st year Post Graduate M.D Pathology
  2. 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. 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. 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. 5. USG
  6. 6. USG
  7. 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. 8. Scanner View
  9. 9. Low power view
  10. 10. High power view
  11. 11. High power view
  12. 12. High power view Encysted larval forms
  13. 13. Impression  F/S/O Breast nodule with adult worms of Filariasis
  14. 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. 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. 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. 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
  18. 18. Microfilaria
  19. 19. 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
  20. 20. 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
  21. 21.  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
  22. 22. 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)
  23. 23. • Serological methods  Fluorescent antibody test  ELISA  IHA  Trop Bio test (ELISA for detection of CFA)  ICT
  24. 24. 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

Editor's Notes

  • one central group of axillary lymph node was identified, measuring 0.9 x 0.5 cm. No necrosis identified. No increased vascularity s/o reactive lymph node or metastasis
  • Cellular smear composed of mixed population of inflammatory cells with filarial worms in the background of necrotic debris with haemorrhage
  • Mixed population inflammatory cells composed of polymorphs, lymphocytes, and eosinophils with worms of Wuchereria bancrofti
  • However, the organisms may be found in any organ of the body, provoking an inflammatory reaction and causing a mass lesion in the absence of the classic signs of filariasis
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