Gravid adult filarial worm in fineneedle breast aspirate mas-

querading as carcinoma

Respected Sir,

Filariasis is endemic in southern Asia, with Wuchereriabancrofti accounting for over 90% of in-fectionsl. Breast isan unusual site of affectation in filariasis and presenceof this infection in fine needle aspirate (FNA) has beendocumented in the,form of case reports only2,3. Thegravid adult worm has been described even on feweroccasions in FNA3. We describe one such interesting casethat clinically masqueraded as carcinoma. A 3Oyear oldfemale presented withtwo nodules felt inher leftbreast.Examination revealed two firm, non-tender, mobilenodules in the left breast, measuring 1.5 ,cm and 2 cm indiameter respectively. There was no axillarylymphadenopathy and her general physicalexamination was normal. The clinical impression wasthat of carcinoma breast. Fine-needle aspirate of theswellings was performed under negative suction using23-G needle and 20 ml disposable syringe. The materialaspirated was smeared onto slides and stained,withMay-Grunwald-Giemsa and haematoxylin- eosinstains. FNA smears from both the breast nodulesrevealed nurnerous sheathed microfilariae and parts oftwo adult female worms. The microfilariae lackedterminal and subterminal nuclei at the caudal end, thusconfirming them to be Wuchereria bancrofti. A largenumber of coiled larvae and microfilariae were seenwithin the gravid adult female worm. The cuticle wasbreached in one of these and many microfilariae wereseento comeoutof the adultworm (Fig.1). The organismincited a florid mixed inflammatory reaction along withforeign body type of giant cells. There was no peripheral

Fig. 1. Photomicrograph showing adult filarial worm with manymicrofilariae (MGG, x140).

Letters to tlrc Editor

eosinophila or microfilaremia. The pathogenesis ofbreast involvement remains conjecturala. It is likelythat retrograde lymphatic spread would have occuredto the breast from the axillary lymphnodes.This case isa pointer to the unusual modes of presentation in acommon parasitic disease. Fine needle aspiration caneffectively provide a quick diagnosis, thus allayingpatient's anxiety and preventing an unnecessarysurgical procedure in a medically treatable condition.This patient was successfully treated with diethyl-carbamazine.

xx?nffiilRadhika Srinivasan

Arvind Rajvanshi

Depnrtment of Cytology €t Gynecological Pathology,Postgraduate Institute of Medical Education and Research,

Chandigarh.

Submitted : 06 April 2004 Accepted: 8 Sepember 2004

Address for Correspondence:Dr. Arvind Rajwanshi,

Prof. andHead,Dept. of Cytology and Gynec Pathology

PGIME& Chandigarh-160012(India)E -mail: arvindrajwanshi@hotmail.com

References

1. Halperin D, Fairfax MR, Bedrossian C. Wuchereria banuofti inBAL fluid of a woman with a concomitant breast lesion. DiagrzCy t op athol 7995 ; 72:285 - 6.

2. Sheri P, Krishnanand G, Gupta A" Mukherjee A. Breast filariasis-a case report. lndian I Pathol Microbiol 2000; a3(3):363-a.

3. Kapila I( Verma K. Diagnosis of parasites in fine needle breastaspirates" Acta Cytol 7996; 40:653-6.

4. Choudhary M.Bancroftian microfilaria in the breast clinicallymimicking malignancy. Cytop a tholo gy 7995 ; 6:132-3.

M icrofi I aria of Wu chereri abancrofti in cervicovaginal

smear

Sir,

Lymphatic filariasis is a major health problem intropical countries especially in India China" Lrdonesiaand parts of Africal In spite of effective controlmeasures, the disease is reported to be increasing,mainly as a result of the human population explosionin endemic areas of the wor1d2. Despite the large number

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of people affected, itis unusual to find microfilariae inroutine rytologic smears. There have been reports ofsingle or small number of cases of microfilariae atvarious sites e.g. bone marrow3, breasta, bronchialaspirates, pleural fluids, cervico-vaginal smearss andpericardial fluid'7 t

Walter et al suggested that microfilariae appear intissue fluids and exfoliated surface material due tolymphatic or vascular obstruction and subsequentextravasations. Aberrant migration is probablydetermined by local factors, such as lymphatic blockageby scars or fumors and damage to vessel walls byinflammatiorg hauma or stasis. The phenomenon of celladhererrce is interesting because it reflects some part ofthe immune status of the patient. Cell adherence tomicrofilariae of I4I Bancrofti was first described byPandit et ale who noted that leukorytes did not adhereto deadmicrofilariae. They concluded that cell adherenceis probably due to presence of filarial antibodies in thesera of these patients.

Here we report a case of a 35 years old female whoattended the Gynaecology O.P.D for II degree prolapse.There was history of irregular bleeding withbloodstained discharge.for the last 2 months. Pap smearwas done as a routine procedure. pytologicalexamination revealed many superficial andintermediate celis with abundant RBCs and alsopolymorphs in the.background. The most remarkablefinding, however, was the presence of microfilariae .

One or more microfilariae present in the smear showeda significant adherence of inflr--utory cells (Fig. 1).Further investigations in the form of peripheral bloodsmear revealed 15 % eosinophilia and wet mount of

Fig. 1. Photomicrograph showing adult filarial worm with manymicrofilariae (MGG, x1a0).

blood revealed moving single microfilaria respectively.The case reported by us did not have clinicalfilariasisand the disease was not suspected prior to the cytologyreport. It was an incidental finding. The patient wassubsequently investigated and was found to havemicrofilariemia. This finding may be consistent withthe observation that in endemic areas, filariasis canexist without microfilaremia, or microfilaraemia maybe extremely transient and therefore overlookedlo.

Aruind G. ValandSushma N. Ramraje

Sanjay Surase

D epartment of P athology,Grant Medical College, Mumbai.

Accepted: 8 September 2004

Address for Correspondence:Dr. A.G. Valand

5117, Doctord Quarters|.|. Hospital Campus,

Bycrrlla, Mumbai - 400 008email - sushmaramraje @ yahoo. com.

References

1. Park JE, Park K. Textbook of preaentioe and social medicine. l?hed. Jabalpur: Banarasidas Bhanot Publishers, 1989.

2. Nelson GS. Current concepts in parasitology- Filariasis. NEngl I Med 7979; 300:7'1.36-9.

3. Rani S, Beohar PC. Microfilaria in bone marrow aspirate - a'case report. Acta Cytol 1981;25:425-6

4. Sodhani P, Murthy DA, Pant CS. Microfilaria in fine needleaspirate from a breast h:l,np. Cytopathology 1993; 4:59-62.

5. Anupindi L, Sahoo R, Rao RV, Varghese G, Rao PVP.Microfilariae in bronchial brushing cytology of symptomaticpulmonary lesions - a report of two cases. Acta Cytol 1993;37:397-9.

Submitted: 11 Mardr 2004

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9. Pandit CG, Pandit SR, Iyer PVS. The adhesion phenomenon infilariasis - a preliminary note. lndian I Med Res 1929; 16l946-53. '

10, Beaver PC. Filariasis without microfilaremia. Am I Trop MedHyg L970; 19:L81.-9.

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