Molluscum contagiosum. A case report with fine needle aspiration cytologic diagnosis and ultrastructural features

Fine Needle Aspiration Cytology of Papulonodular Lesions of Skin: A Study of 50 Cases

INTRODUCTION

Skin is one of the frequent site of disease in human body. Fine Needle Aspiration Cytology (FNAC) is a safe diagnostic method in these cases. FNAC has some limitation, particularly related to representativity of samples, exact typing of skin adnexal tumours and classifying the nature of metastatic cutaneous nodules. Thus, FNAC alone may not give a confirmative diagnosis regarding few skin lesions. Hence, histopathological study has been the standard technique for the diagnosis of skin lesions.

AIM

To study the FNAC findings in various papulonodular lesions and to correlate them with histopathological findings wherever possible.

MATERIALS AND METHODS

In the present study, 50 cases of clinically diagnosed papulonodular lesions were evaluated by FNAC and correlated with histopathology wherever possible.

RESULTS

There was 100% correlation in cases of epidermal cyst, leprosy, tuberculosis, actinomycosis, acute and chronic inflammatory lesions and 67% accuracy was seen in adnexal tumours. Aspiration cytology along with radiological studies proved very useful in classifying the nature of metastatic cutaneous nodules and suggesting the possible site of unknown primary. Sensitivity of FNAC for epidermal cyst and inflammatory lesions was 100%. In case of adnexal tumours, sensitivity and specificity was 67% and 50% respectively.

CONCLUSION

FNAC is a rapid, efficient, cost effective, relatively painless procedure and produces a speedy result with high diagnostic accuracy. It has high rates of sensitivity and specificity in diagnosing papulonodular lesions of skin and hence, is a valuable tool in the diagnosis and management of patients with papulonodular skin lesions.

Scanning electron microscopy of molluscum contagiosum

Molluscum contagiosum is a disease caused by a poxvirus. It is more prevalent in children up to 5 years of age. There is a second peak of incidence in young adults. In order to examine its ultrastructure, three lesions were curetted without disruption, cut transversely with a scalpel, and routinely processed for scanning electron microscopy (SEM). The oval structure of molluscum contagiosum could be easily identified. In its core, there was a central umbilication and just below this depression, there was a keratinized tunnel. Under higher magnification, a proliferation similar to the epidermis was seen. Moreover, there were areas of cells disposed like a mosaic. Under higher magnification, rounded structures measuring 0.4 micron could be observed at the end of the keratinized tunnel and on the surface of the lesion.

Cytological diagnosis of molluscum contagiosum with an unusual clinical presentation at an unusual site

BACKGROUND

Molluscum contagiosum, is a common skin infection caused by a pox virus usually present as raised nodule with umbilicated centre. Cytologic diagnosis has been documented in very few case reports as the lesion is subjected to fine needle aspiration rarely and awareness of the cytological features of Molluscum contagiosum is limited. The cytological diagnosis is further challenging in clinically unsuspected lesions.

MAIN OBSERVATIONS

A 45-year-old female patient presented with 10 months history of a nodular nipple lesion which ulcerated after local application of caustic pencil. There was no associated breast lump. Cheesy material was expressed from the ulcer on the nipple and crush smeared on slides for cytological evaluation. Cytology smears revealed nucleate and anucleate squames in an inflammatory background. Characteristic intracytopalsmic and extracytopalsmic molluscum bodies were seen.

CONCLUSION

The nipple is an unusual site of presentation for Molluscum contagiosum. Ulcerated lesions are rarer. In the present case, the cytological examination facilitated the diagnosis in a clinically unsuspected case. Cytology can be a useful rapid diagnostic aid in planning the management of these patients and help in avoiding unnecessary biopsies.