Filariasis of the breast caused by Brugia pahangi: A concomitant finding with invasive ductal carcinoma

Abstract

Extralymphatic filariasis is an uncommon phenomenon that can be caused by several lymphatic filarial species, including zoonotic filaria of animal origins. In this study, we report a case of a 64-year-old Thai woman who presented with a lump in her left breast that was diagnosed with invasive ductal carcinoma. At the same time, a small nodule was found in her right breast, via imaging study, without any abnormal symptoms. A core needle biopsy of the right breast nodule revealed a filarial-like nematode compatible with the adult stage of Brugia sp. A molecular identification of the nematode partial mt 12rRNA gene and ITS1 suggested the causative species as closely related to Brugia pahangi, a zoonotic lymphatic filaria of animals such as cats and dogs. The sequence of the partial mt 12rRNA and ITS1 gene in this patient was 94% and 99% identical to the previously reported sequence of mt 12rRNA and ITS1 genes of B. pahangi. The sequence of ITS1 gene is 99% similar to B. pahangi microfilaria from infected dogs in Bangkok, which was highly suspected of having a zoonotic origin. As far as we know, this is the first case report of B. pahangi filariasis presented with a breast mass concomitantly found in a patient with invasive ductal carcinoma. This raised serious concern regarding the zoonotic transmission of filariasis from natural animal reservoirs.

Keywords: Breast filariasis; Brugia pahangi; Brugia spp.; Extralymphatic filariasis; Extranodal filariasis; Filariasis.

Fig. 1

Ultrasonography of right breast revealed a small heterogeneous nodule (+), with indistinct margin surrounding hyperechogenicity in the lower inner quadrant (LIQ). No calcification was observed within the mass.

Fig. 2

(a) A section from core needle aspiration of right breast mass revealed a nematode like worm with the presence of pseudocoelom and smooth thin cuticle surrounded with chronic eosinophilic and granulomatous inflammation. (b) Transverse section of nematode revealed a nematode with 2 uterine tubes (U) containing microfilariae (arrow) inside and one intestine (I). It has a few, fully-developed broad muscle per quadrant.