Breast filariasis - A fine needle aspiration cytology report
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- 1. Breast filariasis - A fine needle aspiration cytology report
- 2. Case Report Breast lariasis e A ne needle aspiration cytology report 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 lariasis in human is commonly caused by Wuchereria bancrofti and Brugia malayi. Extranodal lariasis is a rare entity and the breast is an uncommon site for lariasis. We report a case of female who presented with lump in the left breast. Fine needle aspiration cytology of lump revealed numerous adult larial worms. Copyright 2014, Indraprastha Medical Corporation Ltd. All rights reserved. 1. Introduction Lymphatic lariasis or elephantiasis affects more than 90 million people worldwide and has been identied by WHO as thesecondleadingcauseofpermanentandlongtermdisability after leprosy.1 Bancroftian lariasis 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 larial nodule and only a few such cases have been docu- mented. Microlaria and adult worms are detected by needle aspirates from the breast, which aid in the diagnosis and treatmentof disease.2 Wepresentanoldfemale whopresented with lump in the left breast, mimicking carcinoma of breast. 2. Case presentation (clinical details) A 68 year old female who presented with 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 xity to overlying with peau dor- ange. There were no palpable axillary lymphnodes. 3. Cytological ndings 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 microlarias both in coiled and uncoiled forms (Fig. 1). The microlarias were sheathed with elon- gated terminal nuclei and caudal space at the posterior end (Fig. 4). There were scattered ductal epithelial cells, in- ammatory cells and lymphatic uid seen in the back- ground (Figs. 2 and 3). A diagnosis of microlaria 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: email@example.com, firstname.lastname@example.org (A. Hakeem Attar). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/apme a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e3 Please cite this article in press as: Hakeem Attar A, Naseer K, Breast lariasis e A ne needle aspiration cytology report, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.03.001 http://dx.doi.org/10.1016/j.apme.2014.03.001 0976-0016/Copyright 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
- 3. 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 larial cases in the world followed by Brugiamalayi. Female breastis anunusual site for the occurrenceoflarial noduleand few suchcaseshave been documented in literature.1 Other rare unusual sites in which microlaria are reported includes the thyroid nodule, salivary gland, cervicovaginal smear, ovarian cyst uid, bron- chial brushings, effusion uid and gastric brush.2 The common habitat of the adult larial worms is the lymphatic vessels and lymph nodes of limbs and their occurrence in breast is un- common.3 Bancroftian lariasis has a worldwide distribution. Insectsparticularly mosquitoesservesastheintermediatehost. While taking a blood meal the insect ingests microlaria. Over 2 to 3 weeks the MF develop within the insect in to the infective third stage larvae. Theyreenter the denitive human hostwhen the insect feeds again. The larvae mature in to adult worm Fig. 1 e Photomicrograph of Microlaria in a background of Breast tissue (MGG, 1003). Fig. 2 e Photomicrograph of Microlaria in a background of Lymphatic uid (MGG, 4003). Fig. 3 e Photomicrograph of Microlaria in a Lymphoid background (MGG, 4003). Fig. 4 e Photomicrograph of Microlaria in a background of Lymphatic uid (MGG, 4003). a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e32 Please cite this article in press as: Hakeem Attar A, Naseer K, Breast lariasis e A ne needle aspiration cytology report, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.03.001
- 4. 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 microlarial worms. 5. Conclusion To conclude FNA cytology appears to be more convenient and effective diagnostic method in patients with mass lesion. Demonstration and identication of the parasite in the smear played a signicant role in the prompt recognition of the dis- ease and institution of specic therapy. Conicts 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 Cent Surg. 2010;1(11). WMC00942. 2. Singh NG, Chatterjee L. Filariasis of the breast, diagnosed by ne needle aspiration cytology. Ann Saudi Med. 2009;29:414e415. 3. Rukmangadha N, Shanthi V, Kiran CM. Breast lariasis diagnosed by ne needle aspiration cytology e a case report. Indian J Pathol Microbiol. 2006;49(2):243e244. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e3 3 Please cite this article in press as: Hakeem Attar A, Naseer K, Breast lariasis e A ne needle aspiration cytology report, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.03.001
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