Cystic Lymphangioma of Breast due to Filarial Infestation: A Rare Entity

Cystic lymphangiomas are a congenital malformation of the lymphatic system resulting from sequestration of the lymphatic tissue, which no longer interacts normally with the surrounding lymphatic system [1]. Lymphangioma commonly occur in the neck (70%), axilla (30%) or abdomen (10%) [2] and are rare in the breast. A 45 year old female presented in the surgery outpatient department with complains of increasing pain and heaviness in the right breast for 4 months with gradual increase in size of the same breast with no history of nipple discharge and no history suggestive trauma. On examination, a 15 x 18 cm diffuse swelling was present in the right breast involving all the quadrants and extending into right axilla and chest wall upto the clavicle. Swelling was soft with smooth surface, compressible and transilluminant with no axillary lymph nodes. Mammography showed high density lesion suggestive of fibroadenosis. Ultrasonography showed multiple cysts of different sizes and shapes with sepatations, largest cyst measured 2.9 x 1.4 cm.MRI was planned to evaluate the extent of the lesion which revealed right breast lymphatic malformations with subcutaneous and cutaneous mammary congestion on right, multiple non mass enhancing areas in right breast extending into the right axilla and right chest wall upto the clavicle. FNAC was performed under USG guidance cytology revealed lymphocytic preponderance which suggested a benign cystic lesion. The lymphatic malformation involving the right breast was excised through a periareolar incisiona and a separate incision given in the axilla. Histopathology of the specimen was suggestive of cystic lymphangiom as with filarial infiltration into the lymph nodes.USG guided intralesional Bleomycin injection was given in the remnant supraclavicular region. Patient did well during the post operative course.