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Table of Contents
CASE REPORT
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 37-39

Use of FNAC in diagnosis of microfilaria of breast: A case report


1 Professor, Department of Pathology, I.T.S. Dental College, Hospital & Research centre, Greater Noida (U.P.), India
2 Associate Professor, Deparment of Radiology, School of Medical Science & Research, Sharda University, Greater Noida (U.P.), India

Date of Web Publication30-Aug-2018

Correspondence Address:
Vertika Gupta
Professor, Department of Pathology, I.T.S. Dental College, Hospital & Research centre, Greater Noida (U.P.)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240200

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  Abstract 


Extranodal filariasis occurs rarely and breast is an uncommon site for filariasis . The present case is of 23 yrs old female with a painless lump in the left breast involving upper outer quadrant. Provisional clinical diagnosis was Fibroadenoma, left breast. However, cytology smears showed clusters of degenerated ductal cells and several Microfilaria larvae. Thus, a definitive diagnosis of Filariasis, left breast was made. Patient was put on conservative treatment and recovery was uneventful. Therefore, simple yet effective mode of cytological diagnosis was able to avert an unnecessary biopsy/ lumpectomy in this patient.

Keywords: Filariasis, Breast Lump, FNAC(Fine needle aspiration cytology), Wuchereria bancrofti


How to cite this article:
Gupta V, Vats AD, Gupta V. Use of FNAC in diagnosis of microfilaria of breast: A case report. J Integr Health Sci 2016;4:37-9

How to cite this URL:
Gupta V, Vats AD, Gupta V. Use of FNAC in diagnosis of microfilaria of breast: A case report. J Integr Health Sci [serial online] 2016 [cited 2023 Feb 5];4:37-9. Available from: https://www.jihs.in/text.asp?2016/4/2/37/240200




  Introduction Top


Filariasis is a major health problem. Wuchereria bancrofti causes most of the cases that are seen in India and other parts of Asian continent. The most common sites which it affects are the lymph nodes and lymphatic vessels.[1] However, the breast is not a commonly involved site.[2],[3],[4],[5] Microfilaria has been isolated from various other locations such as epididymis, spermatic cord, cervicovaginal smear, lung, thyroid nodule, skin and soft tissue swellings, salivary glands, lymph nodes, nipple discharge, effusion fluids (pleural, pericardial, peritoneal), hydrocele fluid, bone marrow, urine and aspirates from brain and joints.[6],[7],[8],[9]


  Case Report Top


A 23 yr old female patient presented with the chief complaint of painless, slow growing nodule in her left breast for 3 months duration. No history of cough, fever, weight loss, trauma or nipple discharge could be ilicited. There was no family history of breast carcinoma.

Palpation of the breast revealed a firm, discrete, non tender mass, 3.0 x 2.0 cm in size, located in the upper, outer quadrant of left breast. The lump was mobile within the breast tissue and was free from overlying skin and muscles underneath. There were no enlarged axillary lymph nodes. The opposite breast appeared normal. Other physical and medical examinations did not reveal any significant findings.

A 24 gauge needle fitted fitted to a 10 cc syringe was used to perform FNAC. Smears were air dried and wet fixed immediately in fixative (95% ethanol). They were subsequently stained with May-Grunwald-Giemsa and H&E stain respectively. Smears showed clusters of degenerated ductal cells and several Microfilaria larvae. Scattered inflammatory cells were found which included eosinophils, polymorphs, lymphocytes and few histiocytes [Figure 1].
Figure 1: H/E stained smears showed clusters of degenerated ductal cells and several Microfilaria larva. There were scattered inflammatory cells comprising eosinophils, polymorphs, lymphocytes and few histiocytes.

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A cytological diagnosis of Filariasis, left breast was made. A conservative treatment plan was selected for the patient. On follow up, patient showed response to the therapy.


  Discussion Top


Filariasis occurs worldwide but is more prevalent in Asia, Africa and some South American countries. Wuchereria bancrofti (W. bancrofti) causes most of the cases. Other causative agents include Brugia malayi (B. malayi) and Brugia timori (B. timori).[10]

Lymph nodes and lymphatic vessels are main target of Wuchereria bancrofti. It is rare for the female breast to be affected by filariasis and hence not many cases have been cited in the literature.[2],[4],[5] The main causative agent for breast filariasis is W. bancrofti. From areas where B. malayi is endemic, no case has been reported.[11]

Larvae after entering the female breast lymphatics may result in lymphangitis, fibrosis and disruption of lymphatic drainage.[12] The most common site is upper outer quadrant of breast which was also observed in our case. But in literature, central or periareolar nodules as sites for filarial nodules have also been mentioned.(4) Some of the cases of filarial nodule may mimic carcinoma breast due to its hard consistency, attachment to overlying skin causing hyperemia and peau d’orange along with axillary lymphadenopathy.[1],[13]

FNAC has been used to diagnose cases of filarial nodule in breast.[2],[3],[4],[5] In the cytology smears degenerating parasites along with eosinophils, as major inflammatory cell, is the predominant finding as was observed in our case. However, no epithelioid cell granulomas were seen as has been reported in the literature.[14] Kaya and colleagues showed that presence of Microfilaria in blood examinations may not be useful as positivity rate is very low (approximately 12%).[15] Therefore, peripheral blood smear examination as a means of diagnosis in such cases is highly unreliable. Thus, in patients with mass lesions, FNAC can be used as an effective diagnostic tool. In conclusion, demonstration of the parasite in the cytology smear is a reliable mode of diagnosis which prevents unnecessary surgical intervention in such patients.



 
  References Top

1.
Lang AP, Luchsinger IS, Rawling EG. Filariasis of the breast. Archives of pathology & laboratory medicine. 1987 Aug;111(8):757-9.  Back to cited text no. 1
    
2.
Kapila K, Verma K. Diagnosis of parasites in fine needle breast aspirates. Acta cytologica. 1996 Jul 1;40(4):653-6.  Back to cited text no. 2
    
3.
Rukmangadha N, Shanthi V, Kiran CM, Kumari NP, Bai SJ. Breast filariasis diagnosed by fine needle aspiration cytology--a case report. Indian journal of pathology & microbiology. 2006 Apr;49(2):243-4.  Back to cited text no. 3
    
4.
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. 4
    
5.
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. 5
    
6.
Mitra SK, Mishra RK, Verma P: Cytological diagnosis of microfilariae in filariasis endemic areas of eastern Uttar Pradesh. J Cytol; 2009; 26(1): 11-14.  Back to cited text no. 6
    
7.
Sujathan K, Abraham EK. Breast lump suspected for carcinoma diagnosed as filarial granuloma by FNAC: A report of two cases. Austral-Asian Journal of Cancer. 2005;4(1):57-9.  Back to cited text no. 7
    
8.
Jha A, Aryal G, Pant AD, Adhikari RC, Sayami G: Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic. Nepal Med Coll J; 2008; 10(2): 108-114.  Back to cited text no. 8
    
9.
Varghese T, Raghuveer CV, Pai MR, Bansal R. Microfilariae in Cytologic Smears. Acta cytologica. 1996 Jul 1;40(2):299-301.  Back to cited text no. 9
    
10.
Chakrabarti I, Das V, Halder B, Giri A. Adult filarial worm in the aspirate from a breast lump mimicking fibroadenosis. Tropical parasitology. 2011 Jul;1(2):129-31.  Back to cited text no. 10
    
11.
Dayal A, Selvaraju K: Filariasis Of The Breast. Webmed Central Surgery; 2010; 1(11): WMC00942 doi: 10.9754/journal.wmc.2010.00942  Back to cited text no. 11
    
12.
Alkadhi H, Garzoli E. Calcified filariasis of the breasts. New England Journal of Medicine. 2005 Jan 13;352(2):e2.  Back to cited text no. 12
    
13.
Lahiri VL. Microfilariae in nipple secretion. Acta Cytologica 1975; 19:154-5.  Back to cited text no. 13
    
14.
Sahai K, Kapila K, Verma K. Parasites in fine needle breast aspirates—assessment of host tissue response. Postgraduate medical journal. 2002 Mar 1;78(917):165-7.  Back to cited text no. 14
    
15.
Kaya B, Namiki T, Tauchi P. Cytologic diagnosis of banchroftian filariasis: clinical implications. Acta Cytol. 1995; 39:1042.  Back to cited text no. 15
    


    Figures

  [Figure 1]


This article has been cited by
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[Pubmed] | [DOI]



 

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