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• W2090293914 abstract "lettersFilariasis of the breast, diagnosed by fine needle aspiration cytology Naorem G. Singh and Leena Chatterjee Naorem G. Singh From the Department of Pathology, Al Jahra Hospital, Jahra, Kuwait Search for more papers by this author and Leena Chatterjee From the Super Religare Laboratory Limited, New Delhi, India Search for more papers by this author Published Online:1 Oct 2009https://doi.org/10.4103/0256-4947.55178SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: Bancroftian filariasis has a worldwide distribution, with disease prevalence in Africa, Asia including China, India and Southeast Asia, the Caribbean islands, Central and South America.1 It is a major health problem in tropical countries. The breast is an unusual site for the occurrence of a filarial nodule and only a few such cases have been documented.2–5 Microfilariae (MF) and adult worms are detected by needle aspirates from the breast, which aid in the diagnosis and treatment of the disease. Other rare unusual sites in which MF are reported include the thyroid nodule,6 salivary gland,7 cervicovaginal smear,8 ovarian cyst fluid,8 bronchial brushings,8 effusion fluid,8 and gastric brush.9A 29-year-old female presented at the Super Religare Laboratory (formerly SRL Ranbaxy) Gurgaon, India, with a complaint of a mass in the right breast for 3 months duration. On palpation, a small subcutaneous nodule of approximately 9 mm in diameter was identified in the areola. The nodule was firm and nontender. The overlying skin was normal. There was no nipple discharge and the axillary lymph nodes were not palpable. Other physical and medical examinations were unremarkable. Fine needle aspiration (FNA) of the breast nodule was performed using a 23-gauge needle attached to a 10 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 MF both in coiled and uncoiled forms (Figure 1) The MF were sheathed with elongated terminal nuclei and a caudal space at the posterior end (Figure 2) There were scattered inflammatory cells comprising polymorphs, lymphocytes and few histiocytes. No ductal cells were included in the aspirated material. A diagnosis of MF of the breast morphologically consistent with the Wuchereria bancrofti was entertained. Since our establishment was a diagnostic laboratory, the patient was subsequently referred to the concerned physician for the treatment and follow-up, and we have no further information on her disposition.Figure 1 Aspirate showing female adult filarial worm (thick arrow) along with discharged numerous coiled form of larvae (thin arrow) outside the adult worm (May-Grunwald-giemsa stain ×100).Download FigureFigure 2 Microfilarial larvae showing sheathed, terminal nuclei and a caudal space (arrow) at the posterior end (May-Grunwald-giemsa stain ×400).Download FigureBancroftian filariasis has a worldwide distribution. Insects, particularly mosquitoes serve as the intermediate host. While taking a blood meal, the insect ingests MF. Over 2 to 3 weeks, the MF develop within the insect into infective third-stage larvae. They reenter the definitive human host when the insect feeds again. The larvae mature into adult worm 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. Central and periareolar regions are also involved with notable frequency as seen in our case. Multiple lesions are uncommon.5 Most of the lesions manifest as subcutaneous hard mass nodule with cutaneous attachment. More recently, in endemic areas, FNA has been employed to diagnose cases of breast involvement.2–5 In the present case, an FNA smear yielded a fragment of gravid female adult worm along with numerous MF. Cytologic diagnosis of filariasis by FNA from other sites, other than the breast such as the testis, epididymis, thyroid, lung, lymph node and skin, has been reported. A review of these cases by Kaya and colleagues revealed that the positivity for the MF in blood examinations in these patients was approximately 12%.10 Therefore, because of the low yield and stringent sampling requirement of a blood examination, FNA cytology appears to be a more convenient and effective diagnostic method in patient with mass lesions. Thus to conclude, demonstration and identification of the parasite in the smear played a significant role in the prompt recognition of the disease and institution of specific therapy.ARTICLE REFERENCES:1. Lang AP, Fuchsinger IS, Rawling EG. Filarasis of the breast . Arch Pathol Lab Med. 1987; 111:759-9. Google Scholar2. Kapila K, Verma K. Diagnosis of parasites in fine needle aspirates . Acta Cytol. 1996; 40:653-6. Google Scholar3. Rukmangandha N, Santhi V, Kiran CM, Naliri PK, Sarella JB. Breast filariasis diagnosed by fine needle aspiration cytology: a case report . Indian J Pathol Microbiol. 2006; 49:243-4. Google Scholar4. 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. Google Scholar5. Hippargi SB, Kittur SK, Yelikar BR. Filariasis of the breast, diagnosed on fine needle aspiration cytology . J Cytol. 2007; 24:103-4. Google Scholar6. Sodhani P, Nayar M. Microfilaria in a thyroid aspirate smear: An incidental finding . Acta Cytol. 1989; 33:942-3. Google Scholar7. Sahu KK, Pai P, Raghuveer CV, Pai RR. Microfilaria in a fine needle aspirate from the salivary gland . Acta Cytol. 1997; 41:954. Google Scholar8. Walter A, Krishnaswami H, Cariappa A. Microfilariae of Wucheria bancrfti in cytology smears . Acta Cytol. 1982; 27:432-6. Google Scholar9. Singh M, Mehrotra R, Shukla J, Nigam DK. Diagnosis of microfilaria in gastric brush cytology: a case report . Acta Cytol. 1999; 43:853-5. Google Scholar10. Kaya B, Namiki T, Tauchi P. Cytologic diagnosis of banchroftian filariasis: clinical implications . Acta Cytol. 1995; 39:1042. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 29, Issue 5Sep–Oct 2009 Metrics History Published online1 October 2009 InformationCopyright © 2009, Annals of Saudi MedicineThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.PDF download" @default.
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