Filarial Worm or Tumor?

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Filarial worms cause a serious issue in the world. Filariasis usually refers to Wucheria bancrofti and Brugia species; lymphatic filariasis. Filariasis mainly involves the lymphatic system. As of December 2006 1.254 million people in 83 endemic countries were at risk, 64% of which was contributed to South-East Asia Region. When dealing with lumps in breasts of persons from India, it is prudent, then, to keep filariasis (though generally rare in breasts) in mind.

This was exactly the case in the work done by Behera et al., (2008). A 40 year old female presented a ‘peanut sized’ nodule that did not hurt, but was increasing in size. She was clinically diagnosed with a  fibradenoma breast, essentially a benign tumor. The mass was removed from her breast and examined. The examination revealed an adult worm cut in several planes, surrounded by dense inflammatory cells; a granuloma. The granuloma, as we would expect, consisted of lymphocytes, eosinphils, histiocytes, and plasma cells. Behera et al., were able to find the uterus and intestines in a cross section of the worm.

Of all the filariasis cases in the world, W. bancrofti accounts for 90%. Adult worms can be found in lymphatics, subcutaneous tissue, peritoneal and pleural cavities, heart, brain, scrotum, and breast. Very few cases have ever been reported of worms in the breast such as in the case studied by Behera et al., (2008).  The painless breast lumps we know are granulomas, and if left to calcify can damage a decent portion of the breast tissue. Clinically, these granulomas are indistinguishable from carcinoma. In the case of the 40-year-old woman in India, microfilaria were not detected in blood smears, so only the histopathology (microscopic examination) can confirm the presence of the adult worm.  Figure 1 from the article shows the adult worm and granuloma in a photomicrograph. 

Works Cited

Biren Kumar Sarkar, et al. "Adult Filarial Worm In The Tissue Section Of A Breast Lump." Indian Journal Of Surgery 71.4 (2009): 210-212. Academic Search Premier. Web. 1 Nov. 2012.

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