Abstract
Filariasis is an endemic infection caused by nematodes Wuchereria bancrofti and Brugya malayi, highly prevalent in Bihar, Kerala and Tamil Nadu. The disease mainly affects the lymphatics, both channels and nodes. Breast filariasis is rather uncommon, and might mimic a neoplastic breast lump.
Case report
A 42-year old lady presented with a lump in her right breast for the past six months, with no associated pain, nipple discharge nor fever. She had no history of recent lactation nor local trauma. 1
On examination, the skin overlying the right breast showed a ‘peau d’orange’ appearance, but the nipple areaola complex was normal. There was a well-defined lump in right upper quadrant, firm in consistency and not attached to the overlying skin nor underlying chest structures, though it was not as freely mobile a classical as breast mouse or fibroadenoma. A few discrete mobile lymph nodes were palpable in the right axilla. Ultrasonography showed anechoic tubular and linear hyperechoic weblike mobile structures on real-time sonography. Mammography showed a few discrete lobulated masses in the upper outer quadrant of the right breast. Fine-needle aspiration cytology revealed a live adult Filarial worm (Fig. 1), with no evidence of neoplasia. Other supportive investigation reports included peripheral eosinophilia (Absolute eosinophil count 1.1x109) and positive Filarial serology, although the nocturnal peripheral smear for microfilaria was negative. She was treated with Diethylcarbamazine 6 mg/kg/day for two weeks. The swelling subsided and the patient had no further symptoms at 3-month follow-up visit.
Fine-needle aspiration of breast showing microfilariae of Wucheria bancrofti with tail end free from nuclei in the Buffy coat of peripheral smear (Giemsa stain, 400 X).
Discussion
Filarial breast nodules often mimic a neoplastic breast lesion. 2 The most common site of involvement is the upper outer quadrant, though periareolar nodules may also occur. Filarial larvae may cause lymphatic obstruction, lymphangitis and fibrosis. A Filarial breast lump usually presents as a non-tender subcutaneous mass, occasionally associated with inflammatory skin changes, peau de orange and axillary lymph nodes mimicking carcinoma. 3 A high index of suspicion in endemic areas and prompt diagnosis saves patient from apprehension and unnecessary surgical procedures.
Footnotes
Acknowledgements
None.
Declaration of patient consent
The patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
