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DIROFILARIASIS OF THE BREAST
1198 DIROFILARIASIS OF THE BREAST
SIR,-A 51-year-old woman presented with a lump on the pectoral margin of the left breast. She had noticed this one month previously whilst bathing. The lump was "pea sized" and round. It felt attached to the deeper tissues but not to the skin, and carcinoma was suspected. Mammography (Dr D. R. Foster) revealed a small round mass of about 1 cm. The outline was irregular but no evidence of microcalcification was seen. Biopsy was advised, and the lump was resected. The lump was of fibrous/fatty tissue with a central 1-4 cm irregular nodule. Frozen section revealed inflammation with fat necrosis and unidentified foreign material. Paraffin sections revealed a well-circumscribed lesion with a thick fibrous capsule. The capsule had a mantle of lymphocytes, plasma cells, histiocytes, and giant cells with a largely necrotic centre. All sections contained three or four nematode bodies with a diameter up to 570 pm scattered amongst the necrotic exudate (fig 1).
Fig 3-Scanning electronmicrograph of thick section of D repens showing longitudinal striations ( x 355). revealed D repens in 8-3% and D inunitis in 48%. Six further human cases were subsequently described by Pampiglione and colleagues.s Dirofilariasis is very rare in the UK, and has not been rpeorted in the breast. There is a risk of exposure to this nematode during foreign travel.
Fig I-Stained section of nodule with sections of D repens. Haematoxylin and eosin; x 24.
The presence of a body cavity with well-developed musculature attached to the body wall, a thin hypodermis, striated cuticle, and triradiate gut point to a nematode,l and sections of uterus indicate an adult female (fig 2). The presence of developing microfilariae in the uterus and other features (fig 3) indicate a filarial nematode of the genus Dirofilaria.1 Subcutaneous nodules are caused, in the United States, by D tenids and, in Europe, by D repens.3 Provisionally, then, the parasites seen here can be identified as D repens. The patient had been on holiday in Greece in July, 1987, at the time of a severe heatwave. She stayed in an apartment and had eaten out for many of her meals. She recalls many "mangy" cats prowling around the tables at which food was eaten. In 1982 Pampiglione et al4 reported two cases of human subcutaneous dirofilariasis in Venice due to D repens and reviewed some thirty Italian cases of subcutaneous nodules containing a nematode. A parasitological survey on blood from stray dogs captured in and around Venice
Fig 2-Section of D repens showing cuticle, hypodermis musculature, lateral chord, intestine, and uterus ( x 150).
Department of Parasitology, Liverpool School of Tropical Medicine; and Departments of Surgery and Pathology, Princess of Wales Hospital, Bridgend
R. W. ASHFORD
J. A. DOWSE W. N. ROGERS D. E. B. POWELL
1. Chiltwood M, Lichtenfels JR. Identification of parasitic metazon in tissue sections. Exp Parasitol 1972; 32: 407-519. 2. Binford CH, Connor DH. Pathology of tropical and extraordinary diseases: vol II. Washington, DC: Armed forces Institute of Pathology, 1976. 3. Beaver PC, Orihel TC. Human infection with filanae of animals m the United States Am J Trop Med Hyg 1965; 14: 1011-29. 4. Pampiglione S, Franco F, Canestri Trotti G. Human subcutaneous difonlariasis I: two new cases in Venice: identification of the causal agent as Dirafilaria repens. 5.
Parassitologia 1982; 24: 155-65. Pampiglione S, Canestri Trotti G. Squadrini F. Human subcutaneous dirofilariasis II a report of 5 new cases of Dirofilaria repens in central and northern Italy and of a sixth case with uncertain parasitological diagnosis. Parassitologia 1982; 24: 167-76.
LEWIS NEGATIVE GENOTYPE AND BREAST CANCER RISK cancer is sporadic; the remaining 10% of familial. Of all known risk factors for breast cancer the most reliable is a positive family history but more accurate prediction, via some laboratory-measured marker, has not yet proved possible. The Ss blood group has been reported to be associated with breast cancer. We decided to look at various cell membrane surface antigens in groups of women with familial breast cancer (FBC), healthy women with a positive family history of breast cancer (FH), sporadic breast cancer (SBC), and a control group of women. We report our findings with the Lewis antigen system, which was part of that wider study. Familial breast cancer is defined as the occurrence of two or more first-degree relatives with the disease, including the proband. The breast cancer patients and the women with a family history of breast cancer were studied at our breast clinic. 52 patients had FH, 47 were sporadic group, and 119 healthy women had a positive family history. The 100 controls, aged 16-64, were not asked about a family history of breast cancer. Blood and saliva samples were tested with anti lea and leb sera (Biotest UK). With each test batch positive and negative controls were included. Saliva was tested for lea and leb antigens with the inhibition assay. There are three groups within the Lewis antigen system, the expected percentages being Le A (le a + b - ) 22%, Le B (le a - b +) 72%, and Lewis neg (le a - b - ) 6%. Compared with the controls the breast cancer patients, both familial and sporadic, had an
SIR,-90% of breast
cases are
SIR,-A 51-year-old woman presented with a lump on the pectoral margin of the left breast. She had noticed this one month previously whilst bathing. The lump was "pea sized" and round. It felt attached to the deeper tissues but not to the skin, and carcinoma was suspected. Mammography (Dr D. R. Foster) revealed a small round mass of about 1 cm. The outline was irregular but no evidence of microcalcification was seen. Biopsy was advised, and the lump was resected. The lump was of fibrous/fatty tissue with a central 1-4 cm irregular nodule. Frozen section revealed inflammation with fat necrosis and unidentified foreign material. Paraffin sections revealed a well-circumscribed lesion with a thick fibrous capsule. The capsule had a mantle of lymphocytes, plasma cells, histiocytes, and giant cells with a largely necrotic centre. All sections contained three or four nematode bodies with a diameter up to 570 pm scattered amongst the necrotic exudate (fig 1).
Fig 3-Scanning electronmicrograph of thick section of D repens showing longitudinal striations ( x 355). revealed D repens in 8-3% and D inunitis in 48%. Six further human cases were subsequently described by Pampiglione and colleagues.s Dirofilariasis is very rare in the UK, and has not been rpeorted in the breast. There is a risk of exposure to this nematode during foreign travel.
Fig I-Stained section of nodule with sections of D repens. Haematoxylin and eosin; x 24.
The presence of a body cavity with well-developed musculature attached to the body wall, a thin hypodermis, striated cuticle, and triradiate gut point to a nematode,l and sections of uterus indicate an adult female (fig 2). The presence of developing microfilariae in the uterus and other features (fig 3) indicate a filarial nematode of the genus Dirofilaria.1 Subcutaneous nodules are caused, in the United States, by D tenids and, in Europe, by D repens.3 Provisionally, then, the parasites seen here can be identified as D repens. The patient had been on holiday in Greece in July, 1987, at the time of a severe heatwave. She stayed in an apartment and had eaten out for many of her meals. She recalls many "mangy" cats prowling around the tables at which food was eaten. In 1982 Pampiglione et al4 reported two cases of human subcutaneous dirofilariasis in Venice due to D repens and reviewed some thirty Italian cases of subcutaneous nodules containing a nematode. A parasitological survey on blood from stray dogs captured in and around Venice
Fig 2-Section of D repens showing cuticle, hypodermis musculature, lateral chord, intestine, and uterus ( x 150).
Department of Parasitology, Liverpool School of Tropical Medicine; and Departments of Surgery and Pathology, Princess of Wales Hospital, Bridgend
R. W. ASHFORD
J. A. DOWSE W. N. ROGERS D. E. B. POWELL
1. Chiltwood M, Lichtenfels JR. Identification of parasitic metazon in tissue sections. Exp Parasitol 1972; 32: 407-519. 2. Binford CH, Connor DH. Pathology of tropical and extraordinary diseases: vol II. Washington, DC: Armed forces Institute of Pathology, 1976. 3. Beaver PC, Orihel TC. Human infection with filanae of animals m the United States Am J Trop Med Hyg 1965; 14: 1011-29. 4. Pampiglione S, Franco F, Canestri Trotti G. Human subcutaneous difonlariasis I: two new cases in Venice: identification of the causal agent as Dirafilaria repens. 5.
Parassitologia 1982; 24: 155-65. Pampiglione S, Canestri Trotti G. Squadrini F. Human subcutaneous dirofilariasis II a report of 5 new cases of Dirofilaria repens in central and northern Italy and of a sixth case with uncertain parasitological diagnosis. Parassitologia 1982; 24: 167-76.
LEWIS NEGATIVE GENOTYPE AND BREAST CANCER RISK cancer is sporadic; the remaining 10% of familial. Of all known risk factors for breast cancer the most reliable is a positive family history but more accurate prediction, via some laboratory-measured marker, has not yet proved possible. The Ss blood group has been reported to be associated with breast cancer. We decided to look at various cell membrane surface antigens in groups of women with familial breast cancer (FBC), healthy women with a positive family history of breast cancer (FH), sporadic breast cancer (SBC), and a control group of women. We report our findings with the Lewis antigen system, which was part of that wider study. Familial breast cancer is defined as the occurrence of two or more first-degree relatives with the disease, including the proband. The breast cancer patients and the women with a family history of breast cancer were studied at our breast clinic. 52 patients had FH, 47 were sporadic group, and 119 healthy women had a positive family history. The 100 controls, aged 16-64, were not asked about a family history of breast cancer. Blood and saliva samples were tested with anti lea and leb sera (Biotest UK). With each test batch positive and negative controls were included. Saliva was tested for lea and leb antigens with the inhibition assay. There are three groups within the Lewis antigen system, the expected percentages being Le A (le a + b - ) 22%, Le B (le a - b +) 72%, and Lewis neg (le a - b - ) 6%. Compared with the controls the breast cancer patients, both familial and sporadic, had an
SIR,-90% of breast
cases are