Filariasis

Breast nonmalignant
Infectious
Filariasis

Author: Jaya Ruth Asirvatham, M.B.B.S.

Senior Author: Julie M. Jorns, M.D.

Topic Completed: 1 July 2014

Revised: 23 August 2019

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

PubMed Search: Filariasis [title] breast

Page views in 2018: 2,692

Page views in 2019 to date: 2,325

Table of Contents

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

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

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

Additional references

eMedicine: Filariasis [Accessed 17 August 2018]