Breast - nonmalignant
Parasites
Filariasis

Author: Jaya Ruth Asirvatham M.B.B.S., M.D. (see Authors page)
Editor: Julie M. Jorns, M.D.

Revised: 28 July 2017, last major update July 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Filariasis [title] breast

Cite this page: Filariasis. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastfilariasis.html. Accessed October 20th, 2017.
Definition / general
  • Lymphatic filariasis is caused by nematodes that inhabit the lymphatic vessels and lymph nodes of a human host
Terminology
  • 3 filarial species cause lymphatic filariasis in humans:
    • Wuchereria bancrofti is the most common cause of infections worldwide
    • Brugia malayi and Brugia timori can be the causative organisms in Asia
    • Dirofilarial infection of the breast has also been reported (Breast Care (Basel) 2012;7:487)
Epidemiology
  • Endemic in Central Africa and Southeast Asia
  • Humans are the only host for W. bancrofti filariasis
  • Brugian filariasis can affect wild and domestic animals
Sites
  • Inguinal lymph nodes and lower extremities are most commonly involved
  • Can affect the arms, breast and genitalia
Pathophysiology
  • Microfilaria enter the lymphatic vessels of mammary gland and develop into adult worms, disrupting lymphatic drainage
  • Intact adult worms produce minimal tissue reaction but can cause obstruction leading to lymphedema (peau d'orange skin: mimics malignancy)
  • Degenerating / dying worms provoke an inflammatory reaction forming a mass with eosinophilic and granulomatous inflammation
  • Some of the inflammation is in response to antigens of the endosymbiotic bacteria Wolbachia, which the filarial worms contain
  • Secondary lymphangitis and fibrosis may result
  • Chronic inflammation leads to nonpitting edema, hyperpigmentation and hyperkeratosis and possibly superimposed bacterial infection
  • Adult filiaria mate and release microfilaria into the blood
Etiology
Clinical features
  • Unilateral, soft, nontender swelling, commonly in upper outer quadrant
  • May be mobile from quadrant to quadrant and mimic fibroadenoma
  • May be associated with enlarged lymph nodes and simulate breast carcinoma
  • Overlying skin has induration, hyperpigmentation, dilated veins
Diagnosis
  • Peripheral smear examination for microfilaria
  • Excision biopsy
Laboratory
  • Serological testing
  • Elevated eosinophils and serum IgG4
Radiology description
  • Real time ultrasound may show movement of filarial worms ("filarial dance")
Radiology images

Images hosted on other servers:

Groups of fine linear calcification

Spiral and rod shaped calcification

Case reports
Treatment
  • Diethylcarbamazine to kill microfilaria
  • Surgical treatment may be an option for genital and breast disease
Clinical images

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Ill defined lump

Microscopic (histologic) description
  • Cross section of adult worm with surrounding chronic, eosinophilic and granulomatous inflammation, fibrosis
Microscopic (histologic) images

Images hosted on PathOut server:

Gravid female worm of
Wucheria bancrofti
surrounded by fibrosis (AFIP)



Images hosted on other servers:

Transverse section of adult filarial worm with granuloma

Filarial nematode in spermatic cord

Cytology description
  • Fragments of adult worms, gravid female worms, microfilariae, macrophages, variable epithelioid granulomas, other acute or chronic inflammatory cells (Diagn Cytopathol 2011;39:8)
Cytology images

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Blood smears

Differential diagnosis
Additional references