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HISTOPATHOLOGY SECTION - BRIEF COMMUNICATION Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 85-86
Filarial granuloma in breast


Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Hingna, Nagpur, Maharastra, India

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   Abstract 

A case of filarial granuloma in breast in a 59-year-old female is reported. Adult worm was identified in a breast nodule.

Keywords: Filarial granuloma, breast

How to cite this article:
Patrikar A, Maimoon S, Mahore S. Filarial granuloma in breast. Indian J Pathol Microbiol 2008;51:85-6

How to cite this URL:
Patrikar A, Maimoon S, Mahore S. Filarial granuloma in breast. Indian J Pathol Microbiol [serial online] 2008 [cited 2014 Sep 23];51:85-6. Available from: http://www.ijpmonline.org/text.asp?2008/51/1/85/40411



   Introduction Top


Filariasis is a major public health problem in tropical countries. It is endemic in large areas of India, Africa, and Far East. [1] The breast is an unusual site for the occurrence of filarial nodule and few such cases have been documented. [2],[3] Microfilariae (MF) and adult worms have been detected in tissue sections and needle aspirates from the breast, and aid in the diagnosis and treatment of the disease. Adult worms and MF should be sought in all unexplained granulomas of the breast. [4]


   Case History Top


A 59-year-old female patient presented with a nodule in the right breast of one week-duration. It was painless and gradually increasing in size. Clinical examination revealed a small nodule in the upper outer quadrant of the right breast measuring 2 x 1 cm 2 . Dimpling was present on the skin overlying the nodule. There was no axillary lymphadenopathy. Clinically the differential diagnosis was kept as i) carcinoma breast ii) fibroadenosis.

FNA smears showed many foamy macrophages and was reported as an inflammatory lesion, probably fat necrosis. The excised nodule was received for histopathological examination.

Pathological findings

Gross examination

A single, irregular, lobulated, yellowish tissue piece, soft to firm in consistency, measuring 2.1 x 1.5 x 1.5 cm 3 was received. Cut surface was yellowish white, with two whitish areas.

Microscopic examination

Revealed a nodule composed of adipose tissue. Center of the nodule showed an adult worm cut in several planes, surrounded by dense inflammatory cell infiltrate consisting of lymphocytes, a few eosinophils, foamy histiocytes, and small multinucleated giant cells [Figure - 1]. Cross section of this worm showed paired tubular structures containing small round bodies (uterus) and an empty tubular structure (intestine). The surrounding breast tissue was unremarkable.

Diagnosis

A histopathological diagnosis of filarial granuloma in the breast was given.


   Discussion Top


Filariasis is a health problem of huge magnitude. It is endemic in large areas of India, Africa, and Far East. Wuchereria bancrofti ( W. bancrofti ) accounts for approximately 90% of all filariasis cases in the world followed by Brugia malayi ( B. malayi ) and Brugia timori ( B. timori ). Wuchereria Bancrofti is the predominant species accounting for 98% of the national burden.

Lymphatic filariasis is commonly caused by W. bancrofti and B. malayi . The diagnosis is usually on clinical grounds especially in endemic areas. Tests used for diagnosis include demonstration of MF in peripheral blood or skin and detection of filarial antigen and antibody. Adult worms can be detected in lymphatics or scrotum and breast in the affected person.

Female breast is an unusual site for the occurrence of filarial nodule and few such cases have been documented in literature. [2],[3],[5],[6] It is frequently caused by W. bancrofti . The patients usually present with solitary, nontender, painless, and unilateral breast mass. Multiple lesions are uncommon. The upper outer quadrant is the most common site. But central or periareolar nodules occur with notable frequency. [5] Most of the lesions involve subcutaneous tissue and present as a hard mass with cutaneous attachment. Sometimes accompanying inflammatory changes including edema of the skin make it clinically indistinguishable from carcinoma. [6]

The diagnosis of mammary involvement by W. bancrofti is dependent on the specific microscopic structural features of the adult worm and MF. [7] In the present case, MF were not demonstrable in night blood smears. Only histopathology confirmed the presence of adult worm and showed a prominent granulomatous inflammatory reaction around it. Fine needle aspiration yielded mostly foamy macrophages and the lesion was reported as inflammatory.

Filarial granuloma in the breast though not a common occurrence in India is common in some endemic areas like China and Sri Lanka. [4],[8] Therefore adult worms and MF should be sought in all unexplained granulomas of the breast. [4]

The condition responds to diethylcarbamazipine therapy, which in many instances can lead to complete dissolution of the lump.

 
   References Top

1.Filariae of lymphatics. In: Gutierrez Y, editor. Diagnostic pathology of parasitic infections with clinical correlations. 1 st ed. Philadelphia, London: Lea & Febigar; 1990. p. 284-300.  Back to cited text no. 1    
2.Kaplia K, Verma K. Diagnosis of parasites in fine needle aspirates. Acta Cytol 1996;40:653-6.  Back to cited text no. 2    
3.Rukmangandha N, Shanthi V, Kiran CM, Nalini PK, Sarella JB. Breast filariasis diagnosted by fine needle aspiration cytology - a case report. Indian J Pathol Microbiol 2006;49:243-4.  Back to cited text no. 3    
4.Yuechan C, Qun X. Filarial granuloma of the female breast: a histopathological study of 131 cases. Am J Trop Med Hyg 1981;30:1206-10.  Back to cited text no. 4    
5.Pant I, Singh PN, Singh SN. Filariasis of breast - a report of two cases, an unusual site to be involved, J Cytol 2003;20:206-7.  Back to cited text no. 5    
6.Hippargi SB, Kittur SK, Yelikar BR. Filariasis of the breast, diagnosed on fine needle aspiration cytology. J Cytol 2007;24:103-4.  Back to cited text no. 6    
7.Meyers MM, Neafic RC, Connor DH. Bancroftian and Malayan filariasis. In : Binford CH, Connor DH, editors. Pathology of tropical and extraordinary diseases. Vol. 2. Washingon, D.C.: Armed Forces Institute of Pathology; 1976. p. 340-55.  Back to cited text no. 7    
8.Chandrasoma PT, Mendis KN. Filarial infection of the breast. Am J Trop Med Hyg 1978;27:770-3.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]

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DOI: 10.4103/0377-4929.40411

PMID: 18417870

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    Figures

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    Abstract
    Introduction
    Case History
    Discussion
    References
    Article Figures

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