Coexistence of microfilaria with metastatic adenocarcinomatous deposit from breast in axillary lymph node cytology: A rare association
Identifieur interne : 002291 ( Pmc/Corpus ); précédent : 002290; suivant : 002292Coexistence of microfilaria with metastatic adenocarcinomatous deposit from breast in axillary lymph node cytology: A rare association
Auteurs : Nibedita Sahoo ; Arpita Saha ; Pritinanda MishraSource :
- Journal of Cytology [ 0970-9371 ] ; 2017.
Abstract
Filariasis is a global social health problem of tropical and sub tropical countries like India.
Url:
DOI: 10.4103/0970-9371.197617
PubMed: 28182075
PubMed Central: 5259929
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Coexistence of microfilaria with metastatic adenocarcinomatous deposit from breast in axillary lymph node cytology: A rare association</title><author><name sortKey="Sahoo, Nibedita" sort="Sahoo, Nibedita" uniqKey="Sahoo N" first="Nibedita" last="Sahoo">Nibedita Sahoo</name><affiliation><nlm:aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</nlm:aff></affiliation></author><author><name sortKey="Saha, Arpita" sort="Saha, Arpita" uniqKey="Saha A" first="Arpita" last="Saha">Arpita Saha</name><affiliation><nlm:aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</nlm:aff></affiliation></author><author><name sortKey="Mishra, Pritinanda" sort="Mishra, Pritinanda" uniqKey="Mishra P" first="Pritinanda" last="Mishra">Pritinanda Mishra</name><affiliation><nlm:aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28182075</idno><idno type="pmc">5259929</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259929</idno><idno type="RBID">PMC:5259929</idno><idno type="doi">10.4103/0970-9371.197617</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002291</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002291</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Coexistence of microfilaria with metastatic adenocarcinomatous deposit from breast in axillary lymph node cytology: A rare association</title><author><name sortKey="Sahoo, Nibedita" sort="Sahoo, Nibedita" uniqKey="Sahoo N" first="Nibedita" last="Sahoo">Nibedita Sahoo</name><affiliation><nlm:aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</nlm:aff></affiliation></author><author><name sortKey="Saha, Arpita" sort="Saha, Arpita" uniqKey="Saha A" first="Arpita" last="Saha">Arpita Saha</name><affiliation><nlm:aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</nlm:aff></affiliation></author><author><name sortKey="Mishra, Pritinanda" sort="Mishra, Pritinanda" uniqKey="Mishra P" first="Pritinanda" last="Mishra">Pritinanda Mishra</name><affiliation><nlm:aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Cytology</title><idno type="ISSN">0970-9371</idno><idno type="eISSN">0974-5165</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Filariasis is a global social health problem of tropical and sub tropical countries like India. <italic>W.bancrofti</italic> accounts for 95% of cases of lymphatic filariasis. Microfilaria in cytosmears are a rare finding. We report a case of 55 year old female presented with right axillary swelling with ipsilateral breast lump. Cytosmears from the lymph node aspirate showed metastatic adenocarcinomatous deposits and a bunch of microfilariae surrounding the tumor cells and the aspirate from the breast shows ductal carcinoma. We report an additional case of a rare association of microfilaria co-existing with carcinomatous deposit in the lymph node.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Park, K" uniqKey="Park K">K Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Varghese, R" uniqKey="Varghese R">R Varghese</name></author><author><name sortKey="Raghuveer, Cv" uniqKey="Raghuveer C">CV Raghuveer</name></author><author><name sortKey="Pai, Mr" uniqKey="Pai M">MR Pai</name></author><author><name sortKey="Bansal, R" uniqKey="Bansal R">R Bansal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sinha, Bk" uniqKey="Sinha B">BK Sinha</name></author><author><name sortKey="Prabhakar, Pc" uniqKey="Prabhakar P">PC Prabhakar</name></author><author><name sortKey="Kumar, A" uniqKey="Kumar A">A Kumar</name></author><author><name sortKey="Salhotra, M" uniqKey="Salhotra M">M Salhotra</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gupta, S" uniqKey="Gupta S">S Gupta</name></author><author><name sortKey="Sodhani, P" uniqKey="Sodhani P">P Sodhani</name></author><author><name sortKey="Jain, S" uniqKey="Jain S">S Jain</name></author><author><name sortKey="Kumar, N" uniqKey="Kumar N">N Kumar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gupta, K" uniqKey="Gupta K">K Gupta</name></author><author><name sortKey="Sehgal, A" uniqKey="Sehgal A">A Sehgal</name></author><author><name sortKey="Puri, Mm" uniqKey="Puri M">MM Puri</name></author><author><name sortKey="Sidhwa, Hk" uniqKey="Sidhwa H">HK Sidhwa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walter, A" uniqKey="Walter A">A Walter</name></author><author><name sortKey="Krisnaswami, H" uniqKey="Krisnaswami H">H Krisnaswami</name></author><author><name sortKey="Cariappa, A" uniqKey="Cariappa A">A Cariappa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chowdhary, M" uniqKey="Chowdhary M">M Chowdhary</name></author><author><name sortKey="Langer, S" uniqKey="Langer S">S Langer</name></author><author><name sortKey="Aggarwal, M" uniqKey="Aggarwal M">M Aggarwal</name></author><author><name sortKey="Agarwal, C" uniqKey="Agarwal C">C Agarwal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kolte, Ss" uniqKey="Kolte S">SS Kolte</name></author><author><name sortKey="Satarkar, Rn" uniqKey="Satarkar R">RN Satarkar</name></author><author><name sortKey="Mane, Pm" uniqKey="Mane P">PM Mane</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Katti, Tv" uniqKey="Katti T">TV Katti</name></author><author><name sortKey="Athanikar, Vs" uniqKey="Athanikar V">VS Athanikar</name></author><author><name sortKey="Ananthrao, As" uniqKey="Ananthrao A">AS Ananthrao</name></author><author><name sortKey="Rathod, Cv" uniqKey="Rathod C">CV Rathod</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Cytol</journal-id><journal-id journal-id-type="iso-abbrev">J Cytol</journal-id><journal-id journal-id-type="publisher-id">JCytol</journal-id><journal-title-group><journal-title>Journal of Cytology</journal-title></journal-title-group><issn pub-type="ppub">0970-9371</issn><issn pub-type="epub">0974-5165</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28182075</article-id><article-id pub-id-type="pmc">5259929</article-id><article-id pub-id-type="publisher-id">JCytol-34-43</article-id><article-id pub-id-type="doi">10.4103/0970-9371.197617</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Coexistence of microfilaria with metastatic adenocarcinomatous deposit from breast in axillary lymph node cytology: A rare association</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Sahoo</surname><given-names>Nibedita</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Saha</surname><given-names>Arpita</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Mishra</surname><given-names>Pritinanda</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib></contrib-group><aff id="aff1">Department of Pathology, AIIMS, Bhubaneswar, Odisha, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Pritinanda Mishra, Department of Pathology, AIIMS, Bhubaneswar, Odisha, India. E-mail: <email xlink:href="drpritinanda@yahoo.com">drpritinanda@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Mar</season><year>2017</year></pub-date><volume>34</volume><issue>1</issue><fpage>43</fpage><lpage>45</lpage><permissions><copyright-statement>Copyright: © 2017 Journal of Cytology</copyright-statement><copyright-year>2017</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.</license-p></license></permissions><abstract><p>Filariasis is a global social health problem of tropical and sub tropical countries like India. <italic>W.bancrofti</italic> accounts for 95% of cases of lymphatic filariasis. Microfilaria in cytosmears are a rare finding. We report a case of 55 year old female presented with right axillary swelling with ipsilateral breast lump. Cytosmears from the lymph node aspirate showed metastatic adenocarcinomatous deposits and a bunch of microfilariae surrounding the tumor cells and the aspirate from the breast shows ductal carcinoma. We report an additional case of a rare association of microfilaria co-existing with carcinomatous deposit in the lymph node.</p></abstract><kwd-group><kwd>Cytology</kwd><kwd>metastatic adenocarcinoma</kwd><kwd>microfilaria</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Filariasis is a major public health problem in tropical and subtropical countries such as India, China, Indonesia, Africa, and the Far East.[<xref rid="ref1" ref-type="bibr">1</xref>] Despite its high incidence, it is infrequent to find microfilaria in fine-needle aspiration cytology (FNAC) smears and body fluids. The diagnosis is conventionally made by demonstrating microfilariae in peripheral blood smears. However, microfilariae have been coincidentally detected in FNAC in association with various inflammatory and neoplastic lesions in clinically unsuspected cases of filariasis with absence of microfilariae in the peripheral blood.[<xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref>] Although coexistence of microfilaria with carcinoma breast have been reported, we report the first case of coexistence of microfilaria with secondary deposits from ductal carcinoma of the breast in FNAC of axillary lymph node.</p></sec><sec id="sec1-2"><title>Case Report</title><p>A 55-year-old female presented to the surgical outpatient department with a right axillary swelling since 2 months. On examination, there was a soft-to-firm, mobile, nontender lump in the right upper outer quadrant of the breast approximately 3 × 3 cm in size. No history of nipple discharge was present. There was associated ipsilateral axillary lymphadenopathy of size 2 × 2 cm. Aspiration was done from both the sites, which yielded hemorrhagic aspirate. Smears were stained with May-Grόnwald/Giemsa (MCG) and hematoxylin and eosin (H and E). Microscopic examination of the aspirate from both the sites showed cellular smears with malignant epithelial cells in clusters, acinar pattern, sheets, and scattered discretely. The tumor cells were pleomorphic with high nuclear–cytoplasmic ratio, irregular nuclear outline, coarse chromatin, with conspicuous one to two nucleoli. However, the lymph node aspirate showed sheathed microfilariae along with tumor cells [Figure <xref ref-type="fig" rid="F1">1a</xref> and <xref ref-type="fig" rid="F1">b</xref>]. <italic>Wuchereria bancrofti</italic> was identified by the presence of hyaline sheath, multiple coarse, discrete nuclei extending from the head to tail and the tail tip free of nuclei [<xref ref-type="fig" rid="F1">Figure 1b</xref>]. Peripheral smear prepared from the midnight sample revealed eosinophilia but no microfilaria.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>(a and b) Smears from ipsilateral axillary lymph node aspirate showing sheathed microfilaria along with pleomorphic malignant ductal epithelial cells. ((MGG, ×200) [Inset H&E, ×400])</p></caption><graphic xlink:href="JCytol-34-43-g001"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>Discussion</title><p>Filariasis is a global health problem with 1.3 billion people living in areas where the disease is endemic. It is caused by three closely related nematodes, namely <italic>Wuchereria bancrofti</italic>, <italic>Brugia malayi</italic>, and <italic>Brugia timori</italic>, among which <italic>W. bancrofti</italic> accounts for 95% of the cases of lymphatic filariasis. Heavily infected areas in India are Uttar Pradesh, Bihar, Jharkhand, Andhra Pradesh, Odisha, Tamil Nadu, Kerala, and Gujarat.[<xref rid="ref1" ref-type="bibr">1</xref>]</p><p>Despite its high incidence it is infrequent to find microfilaria in FNAC smears and body fluids. The diagnosis is conventionally made by demonstrating microfilariae in peripheral blood smear. However, microfilariae have been coincidentally detected in FNAC in association with various inflammatory and neoplastic lesions in clinically unsuspected cases of filariasis with absence of microfilariae in the peripheral blood.[<xref rid="ref2" ref-type="bibr">2</xref><xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref>] Although coexistence of microfilaria with carcinoma breast have been reported, we report the first case of coexistence microfilaria with secondary deposits from ductal carcinoma of breast in FNAC of axillary lymph node.</p><p>Lymphatic filariasis may manifest as acute, chronic, and asymptomatic disease. Eosinophilia and microfilaremia are common in acute phase.[<xref rid="ref1" ref-type="bibr">1</xref>] The chronic stage of bancroftian filariasis is characterized by lymphadenopathy, lymphedema, hydrocele, and elephantiasis, and is caused by lymphatic blockage. A significant number of infected individuals in endemic areas remain asymptomatic throughout their life. They serve as an important source of infection in the community. FNAC is valuable in the detection of asymptomatic and clinically unsuspected cases of filariasis. In the study done by Walter <italic>et al</italic>., an initial diagnosis of filariasis was made from the cytological smear in all 35 cases; none had clinical filariasis.[<xref rid="ref6" ref-type="bibr">6</xref>] There are few cases of microfilaria at unusual sites such as lymph node, breast lump, thyroid masses, bone marrow, bronchial aspirate, nipple secretion, pleural fluid, pericardial fluid, ovarian cyst fluid, and cervicovaginal smears in the literature.[<xref rid="ref7" ref-type="bibr">7</xref>]</p><p>The presence of microfilariae along with neoplasms is speculated to be a chance association.[<xref rid="ref8" ref-type="bibr">8</xref>] It is very unusual to find microfilaria in metastatic lymph nodes.[<xref rid="ref8" ref-type="bibr">8</xref>] We have found only few case reports of microfilaria along with secondary deposits.[<xref rid="ref8" ref-type="bibr">8</xref>] This may be due to transmigration of microfilaria along with metastatic tumor emboli or because lymph nodes are the normal habitation for the filarial organisms. Because these parasites circulate in the vascular and lymphatic systems, their appearance in tissue fluids and exfoliated surface material would possibly occur under conditions of lymphatic obstruction by scars or tumors and damage due to inflammation, trauma, or stasis. In neoplasms, the rich vascularity could possibly encourage the concentration of parasite at that site.[<xref rid="ref3" ref-type="bibr">3</xref>] Their presence can also be explained by the fact that larvae may be present in the vasculature, and during aspiration, rupture of vessels may result in hemorrhage and release of microfilariae.[<xref rid="ref4" ref-type="bibr">4</xref>] Microfilariae have been reported in association with neoplastic lesions such as squamous cell carcinoma of maxillary antrum, carcinoma of the pharynx, follicular carcinoma of thyroid, carcinoma of the breast, carcinoma of the pancreas, squamous cell, and undifferentiated carcinoma of the uterine cervix, Ewing's sarcoma of the bone, fibromyxoma, lymphangiosarcoma, transitional cell carcinoma of bladder, metastatic melanoma to the bladder, seminoma of undescended testis, leukemia, non-Hodgkin lymphoma, anaplastic astrocytoma of the thalamus, intracranial hemangioblastoma, meningioma, and craniopharyngioma.[<xref rid="ref9" ref-type="bibr">9</xref>]</p></sec><sec sec-type="conclusion" id="sec1-4"><title>Conclusion</title><p>To conclude, filariasis may be incidentally detected in FNAC smears in clinically unsuspected cases with absence of microfilaria in peripheral blood. The present case emphasizes that careful screening of cytology smears can detect microfilaria even in asymptomatic patients, especially in endemic areas to prevent disabling complications of the disease.</p><sec id="sec2-1"><title>Financial support and sponsorship</title><p>Nil.</p></sec><sec id="sec2-2" sec-type="COI-statement"><title>Conflicts of interest</title><p>There are no conflicts of interest.</p></sec></sec></body><back><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Park</surname><given-names>K</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Park</surname><given-names>K</given-names></name></person-group><source>Lymphatic Filariasis. 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