Breast filariasis - A fine needle aspiration cytology report

Case Report

Breast filariasis e A fine needle aspiration cytologyreport

Abdul Hakeem Attar*, K. Naseer

Department of Pathology & Medicine, ESIC Medical College & Owais Hospital Gulbarga, India

a r t i c l e i n f o

Article history:

Received 14 January 2014

Accepted 11 March 2014

Available online xxx

Keywords:

Wuchereria bancrofti

Filariasis

Fine needle aspiration cytology

a b s t r a c t

Filariasis is a major health problem in tropical countries. The disease is endemic in large

areas of India. Lymphatic filariasis in human is commonly caused by Wuchereria bancrofti

and Brugia malayi. Extranodal filariasis is a rare entity and the breast is an uncommon site

for filariasis. We report a case of female who presented with lump in the left breast. Fine

needle aspiration cytology of lump revealed numerous adult filarial worms.

Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

1. Introduction

Lymphatic filariasis or elephantiasis affects more than 90

million people worldwide and has been identified by WHO as

thesecond leadingcauseofpermanentand long termdisability

after leprosy.1 Bancroftian filariasis has a worldwide distribu-

tion with disease prevalence in Africa, Asia including China,

India and Southeast Asia. It is a major problem in tropical

countries.2 The breast is an unusual site for occurrence of a

filarial nodule and only a few such cases have been docu-

mented. Microfilaria and adult worms are detected by needle

aspirates from the breast, which aid in the diagnosis and

treatmentofdisease.2Wepresentanold femalewhopresented

with lump in the left breast, mimicking carcinoma of breast.

2. Case presentation (clinical details)

A 68 year old femalewho presentedwith a painless lump in the

left breast of one year duration. It was gradually increasing in

size. On examination there was a single hard non-tender lump

measuring about 4 � 5 cm and was located in the upper outer

quadrant of the breast with fixity to overlying with peau d’or-

ange. There were no palpable axillary lymphnodes.

3. Cytological findings

Fine needle aspiration of the breast nodule was performed

using a 22 e gauge needle attached to a 5 ml disposable

syringe. The aspirate was smeared on a slide, air-dried and

stained with May-Grunwald-giemsa stain. Cytologic

examination revealed a gravid female adult worm along

with numerous microfilarias both in coiled and uncoiled

forms (Fig. 1). The microfilarias were sheathed with elon-

gated terminal nuclei and caudal space at the posterior end

(Fig. 4). There were scattered ductal epithelial cells, in-

flammatory cells and lymphatic fluid seen in the back-

ground (Figs. 2 and 3). A diagnosis of microfilaria of the

breast morphologically consistent with the Wuchereria ban-

crofti was entertained.

* Corresponding author. C/O Abdul Azeem Attar, Shameem Masala Attar Bazar, Gulbarga 585101, India.E-mail addresses: attar.hakeem@gmail.com, attar_hakeem@rediffmail.com (A. Hakeem Attar).

Available online at www.sciencedirect.com

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journal homepage: www.elsevier .com/locate/apme

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Please cite this article in press as: Hakeem Attar A, Naseer K, Breast filariasis e A fine needle aspiration cytology report, ApolloMedicine (2014), http://dx.doi.org/10.1016/j.apme.2014.03.001

http://dx.doi.org/10.1016/j.apme.2014.03.0010976-0016/Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

4. Discussion

Filariasis is a serious socioeconomic and public health problem

of huge magnitude. It is endemic in large areas of India. W.

bancrofti accounts for approximately 90% of all filarial cases in

theworld followedbyBrugiamalayi. Femalebreast is anunusual

site for theoccurrenceoffilarialnoduleand fewsuchcaseshave

been documented in literature.1 Other rare unusual sites in

which microfilaria are reported includes the thyroid nodule,

salivary gland, cervicovaginal smear, ovarian cyst fluid, bron-

chial brushings, effusion fluid and gastric brush.2 The common

habitat of the adult filarial worms is the lymphatic vessels and

lymph nodes of limbs and their occurrence in breast is un-

common.3 Bancroftian filariasis has a worldwide distribution.

Insectsparticularlymosquitoesservesas the intermediatehost.

While taking a bloodmeal the insect ingestsmicrofilaria. Over 2

to 3 weeks the MF develop within the insect in to the infective

third stage larvae.Theyreenter thedefinitivehumanhostwhen

the insect feeds again. The larvae mature in to adult worm

Fig. 1 e Photomicrograph of Microfilaria in a background of

Breast tissue (MGG, 1003).

Fig. 2 e Photomicrograph of Microfilaria in a background of

Lymphatic fluid (MGG, 4003).

Fig. 3 e Photomicrograph of Microfilaria in a Lymphoid

background (MGG, 4003).

Fig. 4 e Photomicrograph of Microfilaria in a background of

Lymphatic fluid (MGG, 4003).

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Please cite this article in press as: Hakeem Attar A, Naseer K, Breast filariasis e A fine needle aspiration cytology report, ApolloMedicine (2014), http://dx.doi.org/10.1016/j.apme.2014.03.001

which lives for 10 to 15 years and produces MF. The patient

usually presents with a solitary painless nodule in the upper

outer quadrant of the breast. Multiple lesions are uncommon.2

FNA has been employed to diagnose cases of breast involve-

ment. In the present case, an FNA smears yielded numerous

microfilarial worms.

5. Conclusion

To conclude FNA cytology appears to be more convenient and

effective diagnostic method in patients with mass lesion.

Demonstration and identification of the parasite in the smear

played a significant role in the prompt recognition of the dis-

ease and institution of specific therapy.

Conflicts of interest

All authors have none to declare.

Acknowledgements

The work was indeed a mammoth task to accomplish

and would not have been possible without active

co-operation, constant strategic support and encouragement

by our beloved e Dean e (ESIC Medical College Gulbarga)dDr.

S Chandrashekhar.

r e f e r e n c e s

1. Dayal A, Selvaraju Ka. Filariasis of the breast. Webmed CentSurg. 2010;1(11). WMC00942.

2. Singh NG, Chatterjee L. Filariasis of the breast, diagnosed byfine needle aspiration cytology. Ann Saudi Med.2009;29:414e415.

3. Rukmangadha N, Shanthi V, Kiran CM. Breast filariasisdiagnosed by fine needle aspiration cytology e a case report.Indian J Pathol Microbiol. 2006;49(2):243e244.

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Please cite this article in press as: Hakeem Attar A, Naseer K, Breast filariasis e A fine needle aspiration cytology report, ApolloMedicine (2014), http://dx.doi.org/10.1016/j.apme.2014.03.001

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