Breast nonmalignant
Infectious
Filariasis


Topic Completed: 1 July 2014

Revised: 23 August 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Filariasis [title] breast

Jaya Ruth Asirvatham, M.B.B.S.
Julie M. Jorns, M.D.
Page views in 2018: 2,692
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Cite this page: Asirvatham JR, Jorns JM. Filariasis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastfilariasis.html. Accessed August 24th, 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
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
Microscopic (histologic) description
  • Cross section of adult worm with surrounding chronic, eosinophilic and granulomatous inflammation, fibrosis
Microscopic (histologic) images

AFIP 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
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