|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 1 | Page : 58-59
Detection of microfilaria on needle aspiration from breast mass: An uncommon finding
Department of Pathology, Prathima Institute of Medical Sciences, Nagnur, Karimnagar, Andhra Pradesh, India
|Date of Acceptance||23-Sep-2013|
|Date of Web Publication||20-Mar-2014|
Department of Pathology, Prathima Institute of Medical Sciences, Nagnur, Karimnagar, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shastry S. Detection of microfilaria on needle aspiration from breast mass: An uncommon finding. Trop Parasitol 2014;4:58-9
Extranodal filariasis is a rare entity, and the breast is also one of the sites for filariasis. Patients commonly present with an underlying lump that may occasionally mimic malignancy. Filariasis is a common public health problem in Southeast Asia. There are approximately 60 million people infected in the region and approximately 31 million people have the clinical manifestation of this disease. Filariasis in India is caused by two closely related nematode worms - Wuchereria bancrofti and Brugia malayi.  The disease mainly involves the lymphatic system of the body. The most frequently involved lymphatics are those of the lower limbs, retroperitoneal tissues, glands, spermatic cord, and epididymis. , Here we present a case of microfilaria detected in breast cytology.
A thirty-year-old female presented with a small lump in the left breast from the past five months, with associated axillary lymphadenopathy. The swelling was located in the lower inner quadrant. The lymph node was of size 1.5 × 1 cm, firm, and mobile (single). Clinically it was diagnosed as a fibroadenoma. An ultrasound of the breast also diagnosed it as a fibroadenoma. The swelling was of size 2 × 2 cm, firm to cystic. There was no nipple retraction [Figure 1]. The adjacent breast was normal. There was no eosinophilia. Fine needle aspiration cytology (FNAC) was performed using a 10 ml disposable syringe and a 23-gauge needle. Straw colored fluid was aspirated. Hemotoxyllin and Eosin and Giemsa-stained smears revealed microfilariae of W. bancrofti along with a few clusters of ductal epithelial cells, with bland nuclear features, in a hemorrhagic background. Higher magnification revealed microfilariae with a clear space at the cephalic and caudal ends [Figure 2] and [Figure 3]. The smears also showed occasional ductal epithelial cells arranged in small clusters and in singles. A diagnosis of microfilariae of W. bancrofti was made. The patient was advised diethylcarbamazine (DEC) and chlorpheniramine maleate. Excision of the lump, follow up of the patient, and other details of the patient were not known as the patient did not follow up after the aspiration was done.
|Figure 1: Photograph showing left breast swelling with axillary lymphadenopathy|
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|Figure 2: Microfilaria of Wuchereria bancrofti with few ductal epithelial cells in the background. [H and E, ×40]|
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|Figure 3: Microfilaria of Wuchereria bancrofti with few ductal epithelial cells in the background. Note the cephalic and tail tip free from nuclei [Figs. a and b, H and E x10 and x40]|
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Filariasis is transmitted by the Culex mosquito and the adult worms live in the lymphatic vessels of the definitive host. The microfilariae are released into the peripheral circulation. Filariasis causes a spectrum of diseases including the following conditions: Asymptomatic microfilaria, acute lymphangitis and lymphadenitis, chronic lymphadenitis, edema of the limbs and genitalia, and tropical pulmonary eosinophilia. 
Despite a large number of people affected worldwide, it is quite unusual to find microfilaria in routine cytological smears and body fluids. There have been case reports of a single or a small number of cases of microfilaremia at the following sites: Bronchial aspirates, pericardial fluid, cervicovaginal smears, joint aspirates, and thyroid masses.
Diagnosis of filarial infection is frequently made on clinical grounds in endemic areas, but demonstration of microfilariae in the circulating blood is the only means by which one can make a definitive diagnosis. 
The main purpose of this case report is to raise the awareness that in tropical countries like India, where filariasis is endemic, it should always be considered as a differential diagnosis of swelling at any site.
Our presentation revealed that microfilaria could even be present at rare sites like the breast. As the patient could not be followed up with a biopsy, the causal role of filariasis in the breast lump could not be established. However, considering such a kind of presentation, careful examination of cytological smears is very important for the prompt recognition of the disease. This will help in the institution of specific treatment, especially in unsuspected and asymptomatic cases in endemic areas. FNAC is extremely useful in identifying filarial infection at uncommon sites like the breast.
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[Figure 1], [Figure 2], [Figure 3]