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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 136-138

Ovarian filariasis presenting as tubo-ovarian mass: Report of a rare case


1 Department of Pathology, Bankura Sammilani Medical College, Bankura, India
2 Department of Pathology, Serum Analysis Centre, Kolkata, West Bengal, India
3 Department of Pathology, Calcutta Medical College, Kolkata, West Bengal, India

Date of Web Publication14-Mar-2017

Correspondence Address:
Anindya Adhikari
Basudevpur, Banipur (PO), Sankrail (PS), Howrah - 711 304, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.201997

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  Abstract 

Filariasis of ovary is rare. Exact incidence is not known. Herein, we report a case of filarial worm affecting right ovary in a 35-year-old female patient who presented with chronic pelvic pain. Ultrasonography of lower abdomen revealed a tubo-ovarian mass on the right side. Right-sided salpingo-oophorectomy was done. Grossly, ovary was slightly enlarged in size (5 cm × 2.5 cm × 2 cm). Cut surface showed several tiny cysts at the periphery. The lumen of the fallopian tube was blocked. Histopathological examination of the ovary showed lymphangiectasia with microfilaria in one of the dilated lymphatics. Few cystic follicles were also seen in the sections. Section from the tube showed features of chronic salpingitis. She was given a course of diethylcarbamazine citrate (DEC) for 3 weeks postoperatively. On follow-up, the patient was doing well without any complication.

Keywords: Ovarian filariasis, pelvic pain, tubo-ovarian mass


How to cite this article:
Mondal SK, Adhikari A, Chakraborty RN, Mandal S. Ovarian filariasis presenting as tubo-ovarian mass: Report of a rare case. CHRISMED J Health Res 2017;4:136-8

How to cite this URL:
Mondal SK, Adhikari A, Chakraborty RN, Mandal S. Ovarian filariasis presenting as tubo-ovarian mass: Report of a rare case. CHRISMED J Health Res [serial online] 2017 [cited 2017 Mar 27];4:136-8. Available from: http://www.cjhr.org/text.asp?2017/4/2/136/201997


  Introduction Top


Adult filarial worms frequently lodge in lymph nodes and lymphatic plexus of male genitalia. Filariasis of female genital tract is rare. All cases mostly present with different gynecological symptoms and not with symptoms related to filarial infection. Our case shows filariasis of ovary, presented with tubo-ovarian (T-O) mass. Due to rarity exact incidence ovarian filariasis is unknown.


  Case Report Top


A 35-year-old female patient presented with chronic pelvic pain for the past 6 months. She was married and had two children. The patient was afebrile and her menstrual history was normal. On examination, there was mild tenderness on deep palpation and a vague small lump was felt on right lower abdomen. There was no evidence of lymphedema elsewhere. Routine blood test showed, total count - 8500/cmm and on differential count – eosinophil was 6%. Ultrasonography of pelvis revealed a T-O mass on the right pelvic zone [Figure 1]a. Right-sided salpingo-oophorectomy was done. Grossly, ovary was slightly enlarged in size (5 cm × 2.5 cm × 2 cm) [Figure 1]b.  Fallopian tube More Details was seen to be adhered with ovary. Cut section showed several tiny cysts at the periphery of ovary. The lumen of the fallopian tube was blocked. Histopathological examination of the ovary showed lymphangiectasia [Figure 2]a with microfilaria in one of the dilated lymphatic space [Figure 2]b. Few cystic follicles were also seen in the sections. Section from the tube showed features of chronic salpingitis. Based on morphology, a diagnosis of ovarian filariasis of Wuchereria bancrofti species was rendered. Postoperatively, her blood was examined in concentration method in addition to thick film examination to detect microfilaria in circulation. However, the result was negative. She was given a course of DEC tablet for 3 weeks postoperatively. We provided her some basic information regarding filariasis too. Three months postoperative follow-up period was uneventful.
Figure 1: (a) Ultrasonography image of tubo-ovarian mass. (b) Gross picture of tubo-ovarian mass

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Figure 2: (a) Photomicrograph showing dilated lymphatics (H and E, ×400). (b) Photomicrograph showing coiled microfilaria inside lumen of a dilated lymph channel (H and E, ×400)

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  Case Discussion Top


There are eight species of filarial worms that can infect human.[1] Four of them are responsible for serious filarial infection – (1) W. bancrofti, (2) Brugia malayi, (3) Onchocerca volvulus, and (4) Loa loa. First two cause lymphatic filariasis and rest two cause nonlymphatic filariasis. In our case, it was microfilaria of W. bancrofti localized to right ovary without any lymphatic manifestations. Human is the definitive host whereas mosquito is the intermediate host of filarial disease. Culex, Anopheles, and Aedes mosquitoes can serve as vector in W. bancrofti infection. Source of infection is person with circulating microfilaria in peripheral blood. Adult female worm is about (50–100 mm) double the length of male worm (about 40 mm long). Microfilariae (Mf) measure about 300 um in length and 8 mm. in breath. Tail tip is free of nucleus. Asymptomatic microfilaremia is the most common presentation. Clinical manifestations are of two types – lymphatic filariasis and occult filariasis due to hypersensitivity. Organ involvement occurs in chronic obstructive stage. Ovarian filariasis has been found in follicular fluid and incidental finding in oophorectomy specimen.[2] In a case report by Sane and Patel adult filarial worm were reported in a specimen of cystic teratoma.[3] Detection of microfilaria in cervical or vaginal smears has been reported as incidental observations.[4] In a case report by Sethi et al., found filarial worm in ovary and mesosalpinx and both patients presented with complaints related to gynecological problems and not filariasis.[5] In another case report by Goel et al., authors reported significant problem in diagnosing ovarian filariasis in young woman due to uncommon presentation.[6] Lyphatic filariasis is usually treated by DEC with a dose of 6 mg/kg/day for 12 days. The World Health Organization recommends large-scale treatment (preventive chemotherapy) for elimination of lymphatic filariasis by stopping the spread of the infection by a single dose of two medicines given annually to an entire at-risk population as albendazole (400 mg) together with either ivermectin (150–200 mcg/kg) or with diethylcarbamazine citrate (DEC) (6 mg/kg).[7]Wolbachia, a rickettsia like endosymbiont bacterium, recognized to be present intracellularly with all stages of Wuchereria contribute significantly to the pathogenesis of the disease. The Wolbachia has been recognized as a target for antifilarial therapy as evidenced by the loss of worm fertility and viability on antibiotic treatment in an extensive series of human trials.[8] In our case, DEC was given for 3 weeks after salpingo-oophorectomy. In another case study of ovarian filariasis in Abidjan by Brahima et al., albendazole and ivermectin were prescribed following ovariectomy.[9] Surgery and medical therapy primarily helps to avoid recurrences.[10],[11]


  Conclusion Top


Filariasis of female genital tract is uncommon. Different reported cases show involvement of uterus, ovary, mesosalpinx, fallopian tube, cystic teratoma, and vulva. Presentations are usually gynecological and not due to filariasis. In India, main vector is Culex fatigans mosquito. Although postoperatively DEC is given more research is needed regarding duration and dose of the drug and targeted treatment against Wolbachia bacteria especially in filariasis of extralymphatic unusual sites.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Park K. Park's Text Book of Preventive and Social Medicine. 18th ed. Jabalpur: Bhanot Publishers; 2005. p. 211.  Back to cited text no. 1
    
2.
Clement PB, Young RH. Tumor like Lesions of Ovary: Atlas of Gynaecologic Surgical Pathology. 3rd ed. China: Elsevier Inc.; 2014. p. 335.  Back to cited text no. 2
    
3.
Sane SY, Patel CV. A filarial worm in the wall of a cystic teratoma of the ovary – A case report. J Postgrad Med 1989;35:217-8.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Mali BN, Joshi JV. Vaginal parasitosis. An unusual finding in routine cervical smears. Acta Cytol 1987;31:866-8.  Back to cited text no. 4
    
5.
Sethi S, Misra K, Singh UR, Kumar D. Lymphatic filariasis of the ovary and mesosalpinx. J Obstet Gynaecol Res 2001;27:285-92.  Back to cited text no. 5
    
6.
Goel P, Tandon R, Saha PK, Prabhakar S, Goel B, Kaur R, et al. A rare case of ovarian and pelvic filariasis. Trop Doct 2013;43:108-9.  Back to cited text no. 6
    
7.
World Health Organization Media Centre. Lymphatic Filariasis: Fact Sheet. Available from: http://www.mediainquiries@who.int. [Last updated on 2016 Oct 01].  Back to cited text no. 7
    
8.
Slatko BE, Taylor MJ, Foster JM. The Wolbachia endosymbiont as an anti-filarial nematode target. Symbiosis 2010;51:55-65.  Back to cited text no. 8
    
9.
Brahima D, Alain Didier A, Gonat Serge Pacôme D, Nguiessan Alphonse A, Abdoul K, Jean-Marie DM. A rare case of ovarian in Abidjan. Case Rep Pathol 2016;2016:4075162.  Back to cited text no. 9
    
10.
World Health Organization (WHO). Meeting of the international task force for disease eradication-29 October 2008. Wkly Epidemiol Rec 2009;86:89-93.  Back to cited text no. 10
    
11.
Iboh CI, Okon OE, Opara KN, Asor JE, Etim SE. Lymphatic filariasis among the Yakurr people of Cross River State, Nigeria. Parasit Vectors 2012;5:203.  Back to cited text no. 11
    


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