|Year : 2018 | Volume
| Issue : 1 | Page : 24-25
Incidental microfilaria in cervical lymph node cytology
Vandana Gite, Maruti Dhakane
Department of Lab Services, Apollo Hospitals, Bilaspur, Chhattisgarh, India
|Date of Web Publication||2-Apr-2018|
Department of Lab Services, Apollo Hospitals, Bilaspur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Although filariasis is a major health problem in tropical countries including India, lymph node is an unusual site to present as filarial nodule. It is rare to find microfilaria in lymph node cytology. However, in the absence of clinical features of filariasis, fine-needle aspiration cytology may help in the diagnosis of lymphatic filariasis. We report this case, presented with filarial lymph node mass and diagnosed incidentally on a fine-needle aspiration.
Keywords: Cytology, lymph node, microfilaria
|How to cite this article:|
Gite V, Dhakane M. Incidental microfilaria in cervical lymph node cytology. Apollo Med 2018;15:24-5
| Introduction|| |
Although filariasis is a major health problem in tropical countries including India, lymph node is unusual site to present as filarial nodule. It is routinely examined in night peripheral blood smears. Lymph nodes are not clinically suspected for filariasis. It has always been detected incidentally while doing fine-needle aspiration cytology's (FNACs) for evaluation of other lesions. However, careful and vigilant screening of smears may lead to its identification and will help in further management.
| Case Report|| |
A 50-year-old male, known diabetic and hypertensive, presented with neck swelling with a history of fever. He had no history of cough, weight loss, or any lumps elsewhere in the body. On clinical examination revealed multiple left cervical lymph nodes, mobile firm and nontender, largest measuring 1.5 cm in diameter. Fine-needle aspiration of cervical lymph nodes was performed which yielded blood mixed aspirate. The smears revealed cellular aspirate with mixed cell population of lymphoid cells with predominantly mature lymphocytes and many large histiocytes having large, round, vesicular nuclei, and prominent nucleoli with emperiopolesis and lymphophagocytosis. Occasional ensheathed, coiled, and slightly curved microfilaria is seen in [Figure 1] and [Figure 2]. A final diagnosis of reactive lymphoid hyperplasia with microfilaria was made. However, thorough histopathological search on lymph node biopsy failed to show microfilaria.
|Figure 1: Ensheathed coiled and curved microfilaria with reactive lymphoid hyperplasia|
Click here to view
|Figure 2: (a and b) Reactive lymphoid hyperplasia with mixed cell population of lymphoid cells having predominantly mature lymphocytes and many large histiocytes having large, round, vesicular nuclei, prominent nucleoli with emperipolesis and lymphophagocytosis|
Click here to view
| Discussion|| |
Filariasis is one of the parasitic diseases endemic in tropical countries, North East Asia and India manifesting as acute, chronic, or asymptomatic disease. Heavily infected areas in India are Uttar Pradesh, Bihar, Jharkhand, Andhra Pradesh, Odisha, Tamil Nadu, Kerala, and Gujarat. It is caused by nematodes Wuchereria bancrofti, Brugia malayi, Brugia timori, Loa-loa, Onchocerca volvulus, Mansonella persta ns, Mansonella Ozzardi, and Mansonella ozzard.Wuchereria bancrofti (95%) and Brugia malayi (5%) are the most common species causing filariasis in India.
Although filariasis is a global health problem, it is infrequent to find microfilaria in FNAC smears of lymph nodes. Microfilariae have been coincidentally detected in FNAC in association with various inflammatory and neoplastic lesions in clinically unsuspected cases of filariasis with the absence of microfilaria in the peripheral blood. Review of literature has shown the presence of the organism in cervicovaginal smears, endometrial smears, nipple secretions, breast aspirates, pleural fluid, bronchial washings, lymph node aspirates, salivary glands carcinoma maxillary antrum, carcinoma pancreas, soft-tissue aspirates, brain aspirates, joint aspirates, Ewing's sarcoma, thyroid nodules, and bone marrow aspirates.,,,,
The presence of microfilaria in our case was an incidental finding and illustrates the importance of careful screening when filariasis is not expected, especially in those with the absence of microfilaria in blood. In our case, fine-needle aspiration of cervical lymph nodes was performed which revealed cellular aspirate with mixed cell population of lymphoid cells having predominantly mature lymphocytes and many large histiocytes having large, round, vesicular nuclei, prominent nucleoli with emperipolesis and lymphophagocytosis along with occasional ensheathed, coiled, and slightly curved microfilaria. However, thorough histopathological search on lymph node biopsy failed to show microfilaria.
To conclude, the absence of microfilaria in peripheral blood does not rule out filariasis. Filariasis can exist without microfilaremia, i.e., the patient has occult filariasis. In occult filariasis, microfilariae are found in affected tissues but not in peripheral blood. Histopathology of lymph nodes may not always show microfilaria or adult worm, as in our case. Therefore, FNAC is recommended as an invaluable tool in the diagnosis of lymphatic filariasis, even in the absence of clinical features of filariasis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Park K, editor. Lymphatic filariasis. In: Park's Textbook of Preventive and Social Medicine. 22nd
ed. Jabalpur, India: M/s Banarsidas Bhanot Publishers; 2013. p. 245-51.
Nutman Thomas B, Weller Peter F. Filarial and Related Infections: Harrison's Principles of Internal Medicine. 6th
ed., Vol. 11. New York: McGraw Hill: 2014. p. 1260-3.
Agarwal PK, Srivastava AN, Agarwal N. Microfilariae in association with neoplasms. Report of six cases. Acta Cytol 1982;26:488-90.
Kishore B, Khare P, Gupta RJ, Bisht SP. Microfilaria of Wuchereria bancrofti
in cytologic smears: A report of 5 cases with unusual presentations. Acta Cytol 2008;52:710-2.
Gupta K, Sehgal A, Puri MM, Sidhwa HK. Microfilariae in association with other diseases. A report of six cases. Acta Cytol 2002;46:776-8.
Jain S, Sodhani P, Gupta S, Sakhuja P, Kumar N. Cytomorphology of filariasis revisited. Expansion of the morphologic spectrum and coexistence with other lesions. Acta Cytol 2001;45:186-91.
Mohan G, Chaturvedi S, Misra PK. Microfilaria in a fine needle aspirate of primary solid malignant tumor of the maxillary antrum. A case report. Acta Cytol 1998;42:772-4.
[Figure 1], [Figure 2]