Synchronous breast filariasis and breast cancer

Lymphatic filariasis is caused by Wuchereria bancrofti (more common) and Brugia malayi. The breast is an uncommon site of involvement, but common in endemic areas of India¹. Imaging plays an important role in the diagnosis. Ultrasound is especially valuable in demonstrating the classical vigorous movement of worms called “filarial dance”².

Breast cancer is the most important cause of cancer-related morbidity and mortality in Indian women³.

Filariasis is tropical vector-borne disease. Some states in India are endemic for filariasis, like Bihar. Adult parasite survives in lymphatics of infected person and produces microfilariae that circulate in patient’s blood. Microfilariae are ingested by Culex mosquitoes where they form larvae, which are transmitted to another person’s skin via mosquito bites. The larvae develop into adult worm¹.

Patients with breast filariasis usually present with painless breast lump.Upper-outer quadrant is most commonly involved. Common differential is malignancy clinically. It may also be mistaken for fibroadenoma in young patients on clinical examination. If there are associated skin changes(hyperaemia or peau-d’orange appearance), there may be clinical confusion with inflammatory breast cancer or mastitis. If blocked lymphatics appear as prominent vessels, Mondor’s disease becomes a differential¹.

In acute and subacute phases, ultrasound is diagnostic. Amaral et al. reported visualisation of adult wormsin scrotum of infected men on ultrasound. It was described as “filarial dance”due to characteristic random movements of worms in lymphatic vessels. Worms are seen as echogenic structures in cystic lesion. Similar findings have been reported in breast, first by Dreyer and colleagues⁴. Rathi et al. described colour motion artifact on Doppler, produced by swirling motion of parasite⁵. Dilated lymphatic vessels are usually seen. But they were not seen in our case, possibly attributed to already involved lymph nodes by carcinoma.

In degenerating phase, there is dystrophic calcification of dead worms, seen as elongated tortuous calcifications which do not conform to ductal pattern on mammogram¹.

Filariasis may also be seen as noncalcified nodules which may be mistaken for fibroadenoma or intramammary lymph-node on mammogram¹.

Diagnosis may be confirmed by fine needle aspiration of lesion⁶.

Treatment includes diethylcarbamazine and albendazole. The prognosis is good if uncomplicated⁶.

Breast cancer is the most common cancer in women in India and accounts for 14% of all cancers in women⁷.

Breast cancer and breast Filariasis to occur in same breast is not a common occurrence. There are no case reports of this in literature.

We would like to present such a case here (with special thanks to Dr. Purvi Haria and the rest of the breast imaging and entire radiology department of Tata Memorial Hospital).