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Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Laboratory | Radiology description | Radiology images | Case reports | Treatment | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Cytology images | Differential diagnosis | Additional referencesCite this page: Asirvatham JR Filariasis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastfilariasis.html. Accessed February 18th, 2019.
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
- Infection is transmitted by mosquito vectors; humans are definitive hosts (CDC: Parasites - Lymphatic Filariasis [Accessed 17 August 2018])
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
- 35 year old man with filariasis presenting as gynecomastia (Breast J 2012;18:83)
- 59 year old woman (Indian J Pathol Microbiol 2008;51:85)
- 69 year old woman (Radiology 2002;222:515)
- 2 adult women with dirofilariasis of breast (Diagn Cytopathol 2002;26:22)
- Woman with filariasis of the breast three years after visiting India (Arch Pathol Lab Med 1987;111:757)
Treatment
- Diethylcarbamazine to kill microfilaria
- Surgical treatment may be an option for genital and breast disease
Clinical images
Images hosted on other servers:
Ill defined lump
Microscopic (histologic) description
- Cross section of adult worm with surrounding chronic, eosinophilic and granulomatous inflammation, fibrosis
Microscopic (histologic) images
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
Images hosted on other servers:
Blood smears
Differential diagnosis
Additional references
