Breast ductal carcinoma with coexistent microfilaria: Diagnosed on cytology

Abstract

Filariasis is a major health problem of the tropical and subtropical regions, but filariae are also found in temperate climates. The disease is endemic all over India and microfilariae have been observed as coincidental findings with inflammatory conditions and neoplastic lesions. We report a rare case of a 40-year-old female from a nonendemic area presenting with lump in the left breast. The skin overlying the mass was fungating and ulcerated. Ipsilateral axillary lymph nodes were palpable. Fine-needle aspiration cytology revealed highly cellular smears having ductal epithelial cells arranged in groups, tight clusters, and scattered singly. Cells were large, having pleomorphic round to oval nuclei with prominent nucleoli. Along with these tumor cells, sheathed microfilariae of Wuchureria bancrofti were seen, suggesting a diagnosis of ductal carcinoma with coexistent microfilaria of W. bancrofti. Findings were confirmed on histopathology of the resected specimen following modified radical mastectomy. Coexistent pathologies should always be considered while reporting.

Cytological diagnosis of microfilaria coexistent with suspected malignancy of breast and ovary in a young pregnant female

“…Filariasis is prevalent in the tropical regions, infecting 120 million people worldwide. 6 In India, maximum number of cases have been reported from Uttar Pradesh, Bihar, Orissa, Jharkhand, Gujarat, Andhra Pradesh, Tamil Nadu and Kerala. It affects young adults in most cases.…”

“…Also, there may or may not be presence of eosinophilia, foreign body giant cell and granulomatous reaction in cytological smears which can aids in the diagnosis. 1,6,7 Several authors have proposed a hypothesis explaining the presence of microfilaria in a malignant lesion. In malignancy, there is obstruction of vascular and lymphatic channels causing extravasation of blood and lymph which may releases microfilaria into the tissues.…”

“…Similarly, while performing FNAC, there may be damage to vessels leading to release of microfilariae into the tissues. [6][7][8] It seems that filariasis does not alter the clinical presentation of a tumour and a patient may, of course, suffer with subclinical filariasis before developing such tumour. The drug of choice for filariasis is ivermectin which is effective against both microfilaria and adult worms.…”

“…Also, there may or may not be presence of eosinophilia, foreign body giant cell and granulomatous reaction in cytological smears which can aids in the diagnosis. 1,6,7…”

An odd curiosity: Meristematic tissue in a breast fine‐needle aspirate

“…Initially, this structure was cataloged as a contaminant even though it did mimic a parasite. Indeed, the presence of microfilariae has been reported in FNA cases . However, careful examination of this structure revealed a series of morphological features that did not correspond with those typically seen in microfilaria (Figure ), such as: Size: these parasitic nematodes measure 120 to 250 μm in length and 3 to 7 μm in width; Shape: roundworms are filiform with two ends, one rounded or cephalic and the other more pointed or terminal; and Nuclei layout: their nuclei are arranged irregularly with some overlap in the middle of the body, with free space between nuclei and their body surface, and a notable absence of nuclei at the ends. …”