Breast filariasis
Introduction
Introduction to breast filariasis Filariasis of breast is a filarial granuloma that occurs when the bloodworm is parasitic in the lymphatic vessels of the breast, causing obstruction of the lymphatic vessels. Both men and women can get sick, but most of them are women. The breast lymphatic vessels of adult women are very rich, especially in pregnancy and breast-feeding breasts. Under the action of sex hormones, the volume becomes larger and the lymphatic vessels expand, which provides more for the parasitic bloodworm. Opportunity. The disease is characterized by breast nodules, and sometimes it is not easy to distinguish from cancer. Therefore, the differential diagnosis of the disease is very important. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: mosquito bites Complications: breast lumps
Cause
Cause of breast filariasis
Direct infection (90%):
After the mosquito infected with the silkworm bites the human skin, the microfilaria enters the lymphatic vessels, and the microfilariae and adult insects enter the lymphatic vessels of the breast, causing filarial lymphangitis, followed by lymphatic endovascular inflammation, forming a habit Acid granuloma and a series of pathological changes.
Environmental factors (10%):
Because it does not pay attention to personal hygiene or public health, it directly or indirectly contacts the secretions, excretions and other items of the diseased patients and does not clean and disinfect in time to cause the infection of the disease.
Lesion
The lymphatic vessels of the breasts of adult women are extremely rich, and there are abundant lymph nodes between the lobules of the breasts and the areola. Most of the lymph nodes of the breasts flow to the axillary lymph nodes outside the breast through the lymphatic trunks. Therefore, the disease has more chances in the upper quadrant of the breast. .
2. Pathological morphology
(1) General form: Filaria-like intra-milk masses are mostly irregular nodules, with a diameter of 1 to 5 cm and an average diameter of 2 to 3 cm. The mass can be single or multiple, and the texture is soft in the early stage and hard in the late stage. There are several small sacs in the center of the lumps. The sacs are filled with gray-yellow or gray-white cheese-like objects, sometimes with jelly and bleeding. The filaments are visible in the blood. The small sac is surrounded by congested granulation tissue. Dense fibrous tissue.
(2) Seen under the microscope: see the lymphatic wall congestion and edema in the lesion area, eosinophils, mononuclear cell infiltration, thickening of the lymphatic wall, fibrin, lymphocytes, eosinophils and other agglutination in the lumen The formed embolus embolizes the lumen, followed by the granulomatous lymphangitis with the dead worm body as the core, and the eosinophilic abscess. The worms and microfilariae are found in the abscess. Perithelium-like cells and multinucleated giant cells, fibroblasts and other tuberculosis-like granuloma can be seen around the abscess. The periphery is surrounded by granulation tissue, and the lesions are fibrotic, calcified, lymphatic vessels are completely occluded, lymphatic stasis, small lymphoid The tube flexes and expands, ruptures, and the lymph fluid enters the interstitial space. In the local part of the lymphatic deposition, the connective tissue hyperplasia is caused by the stimulation of the high-protein-containing lymph fluid, forming a solid and swollen elephantiasis, which is rare in the breast. form.
3. Pathological staging can be divided into three phases according to pathological changes:
1 acute phase: inflammation of the intima and adventitia of the lymphatic vessels.
2 subacute phase: tuberculous lymphangiitis formation.
3 chronic phase: occlusive lymphangitis occurs and calcification is seen.
Prevention
Breast filariasis prevention
Filariasis is one of the four major parasitic diseases in southern China. It spreads through mosquito bites and does not cause illness when living with patients.
In the filariasis epidemic area census patients and people with microfilariae, doing a good job in anti-mosquito and anti-mosquito work is of great significance in the prevention of filariasis.
For the immigrant population to enter the epidemic area, 150 mg of tablets can be taken from the sea group, and once a month, the preventive effect can be achieved.
Complication
Breast filariasis complications Complications breast lumps
Skin adhesions, pain, breast lumps.
Symptom
Symptoms of breast filariasis Common symptoms Female breast superficial ... Inflammatory breast lumps Lymph node enlargement Calcified nodules Subcutaneous nodules Skin adhesions
Single or multiple nodules or masses can be touched in the breast. The masses are mostly located in the upper quadrant of the breast, followed by the central or outer quadrant. The size of the mass is different. The diameter is more than 2~3cm, mostly located under the skin or superficial. In the breast tissue, often involving one side of the breast, early soft, moving is still good, growth is slow, the surface of the skin is mildly red, with mild pain and tenderness, ipsilateral axillary lymph nodes, individual can also be complicated by acute suppurative mammary gland Inflammation, a small number of tumors close to the skin, often cause adhesion to the skin with orange peel-like changes, easily misdiagnosed as breast cancer, mastitis lumps, advanced fibrosis and calcification, resulting in hardening of the nodules, activities are limited, easy Misdiagnosed as breast cancer, fibroadenomas, mammary gland hyperplasia.
Examine
Breast filariasis check
1. Venous blood microfilariae check the midnight earlobe puncture blood, thick, wet blood, microscopic examination can find microfilaria.
2. Immunological examination has strong sensitivity and specificity.
(1) Indirect fluorescent antibody test: the positive rate was 92.8% for the filaria, and 99.1% for the malaysia.
(2) Enzyme-linked immunosorbent assay: The positive rate of filarial antibody positive rate and microfilariae positive rate is about 95%.
3. Fine needle aspiration cytology examination of the breast mass fine needles to absorb cells for smear, microscopically visible micro-filaments and mammary epithelial cells, eosinophils and other components.
4. Breast lumps biopsy often sees filaria or microfilaria larvae in granulation tissue, which can be clearly diagnosed.
5. The lymphatic angiography of the breast shows that the input lymphatic port is larger and the output port is smaller.
Diagnosis
Diagnosis and diagnosis of breast filariasis
diagnosis
The history of filariasis endemic areas, the superficial upper quadrant of the female breast, the hard subcutaneous nodules, like the skin, should consider the possibility of filarial nodules, should ask whether there is filariasis And the history of breast inflammation, men can occasionally see this disease, still need to pay attention, especially in popular areas, for male breast lumps, can not ignore the possibility of this disease.
Differential diagnosis
Breast cancer
(1) History: Most patients with mammary glia have a history of filariasis endemic areas.
(2) Signs: Although the intramammary mass of the filariasis can adhere to the skin, there is little change in the orientation of the nipple and the orange peel of the skin.
(3) The filth cell examination and pathological section of the blood lumps of breast filariasis can be found in the microfilariae of the silkworm, while the fine needle aspiration cytology and pathological section of the breast cancer can be free of cancer cells.
2. Breast tuberculosis
(1) Causes: Breast tuberculosis patients have almost no history of tuberculosis in other organs; breastworm patients have a history of filariasis endemic areas.
(2) The number of breast filarial patients is more than that of breast tuberculosis patients. In the pathological tissue sections of the breast, the former can be found in filamentous or microfilaria, while the latter can be found in typical tuberculosis or tuberculosis.
3. Breast fat necrosis
(1) history of trauma: breast fat necrosis has a history of trauma, physical examination of the mass is hard, more adhesion to the skin, brown spots can be seen at the wound.
(2) Gross specimen: the gross view of the gross fat necrosis of the breast, showing the oil sac and liquefied fat, no bleeding and filth of the silkworm.
(3) Pathological findings: There is no eosinophilic abscess in breast fat necrosis, and there is no excessive amount of eosinophil infiltration and lymphatic lesions.
