LETTER TO THE EDITOR
Year : 2008 | Volume
: 25 | Issue : 3 | Page : 117--118
Microfilaria in a fine needle aspirate of breast carcinoma: An unusual presentation
Binod K Sinha, Praphulla C Prabhakar, Aarti Kumar, Manish Salhotra
Pathology Department, Sanjay Gandhi Memorial Hospital, Mangolpuri, New Delhi, India
A-43, Lajpat Nagar-2, New Delhi - 110 024
|How to cite this article:|
Sinha BK, Prabhakar PC, Kumar A, Salhotra M. Microfilaria in a fine needle aspirate of breast carcinoma: An unusual presentation.J Cytol 2008;25:117-118
|How to cite this URL:|
Sinha BK, Prabhakar PC, Kumar A, Salhotra M. Microfilaria in a fine needle aspirate of breast carcinoma: An unusual presentation. J Cytol [serial online] 2008 [cited 2020 Jun 6 ];25:117-118
Available from: http://www.jcytol.org/text.asp?2008/25/3/117/44052
To the Editor,
Filariasis is a major public health problem in tropical countries like India, with Wuchereria bancrofti (W. bancrofti) being the most common causative organism accounting for about 95% of all filarial infections.  Microfilariae have been observed as coincidental findings with various benign and malignant tumors such as hemangiomas of the liver, meningiomas, intracranial haemangioblastomas, fibromyxomas, squamous cell and undifferentiated carcinomas of the uterine cervix, pharyngeal carcinomas, lymphangiosarcomas, urinary bladder carcinomas, prepucial carcinomas, metastatic carcinomas, melanomas, and leukemia.  We present here an unusual case in which microfilariae were encountered in fine needle aspiration (FNA) smears from a patient with breast carcinoma.
A 40 year-old female presented to our hospital with a lump in her left breast of two months' duration. Clinical examination revealed a 4 x 2 cm firm lump in the upper outer quadrant of the left breast.
Air-dried smears from an FNA procedure stained with Giemsa were highly cellular and comprised of tumor cells in a hemorrhagic background. The tumor cells had moderate cytoplasm with hyperchromatic nuclei. There was moderate nuclear atypia and pleomorphism along with a prominent nucleolus.
Numerous microfilariae were also seen, which were identified as those of Wuchereria bancrofti by the presence of a hyaline sheath, the length of the cephalic space, and the presence of somatic cells (nuclei). The somatic cells appeared as granules that extended from the head to the tail; the tail tip was free of nuclei [Figure 1].
On subsequent investigation with the aid of a peripheral blood smear obtained at night, neither eosinophilia nor the presence of microfilariae was observed. This finding may be consistent with the observation that, in endemic areas, filariasis can exist without microfilaremia, or microfilaremia, may be extremely transient, and therefore, overlooked. 
Various authors have expressed the opinion that because these parasites circulate in the vascular and lymphatic systems, their appearance in tissue fluids and exfoliated surface material would possibly occur only under conditions of lymphatic and vascular obstruction, causing extravasation of blood and release of microfilariae into the blood circulation. Such aberrant migration to these dead end sites is probably determined by local factors such as lymphatic blockage by scars or tumors and damage to the vessel wall by inflammation, trauma, or stasis. In tumors, the rich blood supply could possibly encourage the concentration of parasites at that site.  This hypothesis can explain the occurrence of tumors with microfilariae in many previously reported cases, and it might be a reasonable explanation in our case as well.
Their presence can also be explained by the fact that larvae may be present in the vasculature and aspiration may lead to the rupture of vessels resulting in hemorrhage and the release of microfilariae. 
In the present case, we feel that the presence of microfilaria in association with the neoplasm is an incidental finding and that the patient was possibly harboring subclinical filariasis when the tumor developed. No microfilariae were detected in histopathology slides. This could be due to the fact that the patient was treated with hetrazan therapy prior to surgery.
Our case illustrates the presence of microfilariae in a rare site and in association with a neoplasm. This highlights the importance of screening smears for parasites even in the absence of clinical indications.
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