Breast filariasis

Last revised by Mostafa Elfeky on 3 Nov 2022

Breast filariasis describes filariasis, a parasitic infestation commonly caused by Wuchereria bancrofti and Brugia malayi, of the breast.

Lymphatic filariasis puts at risk more than a billion people in more than 80 countries who are seriously incapacitated or disfigured by the disease. Breast filariasis has been reported in the Indian subcontinent where the organism is endemic.

Clinically presents as a unilateral painless lump in the breast often associated with redness of the overlying skin. Most often the lesions are seen involving the upper outer quadrant of the breast. Sometimes, the skin over the nodule may be hyperemic with changes of peau d'orange, and the axillary nodes may be enlarged.

In lymphatic filariasis, the adult parasites live in the lymphatic vessels while their offspring, the microfilariae, circulate in the peripheral blood and are available to the mosquito vectors when they feed on the human blood.

The larvae enter the lymphatic vessels causing lymphangitis, fibrosis and disruption of lymphatic drainage. Hyperemia and subdermal lymphatic damage lead to the peau d’orange appearance of the breast more commonly associated with malignancies and may cause a clinical dilemma in the diagnosis.

Ultrasound is a valuable tool for demonstrating cases of lymphatic filariasis. Real-time ultrasound may sometimes show a rigorous movement of the adult worm, an appearance labeled as the "filarial dance." Mixed red-blue color Doppler signals are non-rhythmic, non-pulsatile, and possess a characteristic pulse Doppler trace due to irregular worm movement.

The classical mammographic picture of breast filariasis is that of benign-appearing groups of elongated and serpiginous calcification with or without lucent centers, which are located in the connective tissue unrelated to the ducts (distinguishing them from the calcifications of intraductal carcinoma).

Diethylcarbamazine citrate thrice daily for 2 weeks with a 2-week drug-free interval between each course for a period of 3 months.

Dreyer and colleagues first demonstrated the filarial dance in the breast. Rathi et al. described the color motion artifact, which is produced by the swirling motion of the parasite.

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