Incidental Diagnosis of Filariasis in Superficial Location by FNAC: A Retrospective Study of 10 Years

Isolated Epitrochlear Filarial Lymphadenopathy: Cytomorphological Diagnosis of an Unusual Presentation

Filariasis is a major public health problem in tropical countries like India. Despite the large number of people at risk, detection of eggs with or without larva (microfilaria) on fine-needle aspiration cytology is very unusual, especially in an uncommon site or incidentally detected in clinically unsuspected cases of filariasis with the absence of microfilariae in the peripheral blood. A 19-year-old male presented with swelling over medial aspect of left arm (just above the elbow), with no other specific signs and symptoms. Fine needle aspiration cytology revealed an adult gravid female filarial worm in a background of reactive lymphoid cells and lymphohistiocytic clusters. We report a case with elaborate fine needle aspiration cytology findings of filarial worm infestation with unusual presentation of isolated epitrochlear lymph node involvement in a clinically unsuspected case and recommend clinicians and pathologists to consider a high index of suspicion for such infections at uncommon sites especially in endemic territories, as early diagnosis and treatment prevent the more severe manifestations of disease.

Cytological findings of microfilariae in different sites: A retrospective review of 22 cases from endemic region

Background:

Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies.

Aims and Objectives:

The study was undertaken to analyze the prevalence and cytology findings of cases of incidentally found microfilariae in cytology smears (fine-needle aspiration cytology [FNAC]/body fluids) from different body parts.

Materials and Methods:

This was a retrospective study over 5 years, where the cases of microfilariae in aspirates from swelling of different locations and body fluids were reviewed, and clinic-pathological data were analyzed.

Results and Analysis:

Out of 16,738 cases of FNAC and 882 cases of fluid cytology, 22 cases (0.124%) of incidental finding of microfilaria were documented in cytology smears. The cases were diagnosed from lymph nodes (5 cases), skin and soft tissue (4 cases), scrotal (4 cases), breast (3 cases), thyroid (2 cases), and pleural fluid (2 cases). We found eosinophilia in 15 cases (68.18%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions.

Conclusion:

Filariasis should be considered as differential diagnosis of swelling of lymph nodes, skin, soft tissue, inguinoscrotal region, and other sites as well. Careful screening of cytology smears may help in detection of incidental cases in the association of other pathologies.

Wuchereria bancrofti: Unusual Presentation as Pancytopenia

Wuchereria bancrofti is an endemic filarial nematode spread by a mosquito vector. The clinical manifestations vary from asymptomatic microfilaremeia to lymhoedema. We report two cases of microfilaria of Wuchereria bancrofti in bone marrow presenting as peripheral pancytopenia. The patient did not have any classical features of lymphoedema or elephantiasis. The diagnostic demonstration of microfilaria with unusual presentations has been done in cytology specimens from various sites. Microfilaria infection in association with peripheral blood pancytopenia has been rarely reported. An aetiopathological co-relation of these haematological manifestations of microfilaria needs further investigation.

Unusual presentation of filariasis as an abscess: A case report

Bancroftian filariasis, a tropical and subtropical disease caused by Wuchereria bancrofti, is transmitted by the culex mosquito. The disease is conventionally diagnosed by the demonstration of microfilaria in peripheral blood smear. Microfilaria and adult filarial worms have been incidentally detected in fine needle aspiration cytology (FNAC) in various locations. The disease may be missed if one is not aware of the possibility, particularly in cases where eosinophilia is absent. Therefore, clinicians and pathologists need to be more vigilant in the endemic zones for early diagnosis and the treatment of filariasis. We report here an unusual case of filariasis in a 17-year-old female with a swelling in the lower part of the left arm on the flexor surface. This highlights the chances of finding microfilaria in cytology of an unsuspected case at an unusual site. This case, in addition, stresses the fact that microfilaria may be associated with an abscess even in the absence of eosinophilia.