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Year : 2017  |  Volume : 60  |  Issue : 2  |  Page : 288-289
Subcutaneous cysticercosis presenting as cervical swelling: Amazing and unexpected cytological findings


Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Patna, Bihar, India

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Date of Web Publication19-Jun-2017
 

How to cite this article:
Bhadani PP, Jamal I, Kumar S, Smita S. Subcutaneous cysticercosis presenting as cervical swelling: Amazing and unexpected cytological findings. Indian J Pathol Microbiol 2017;60:288-9

How to cite this URL:
Bhadani PP, Jamal I, Kumar S, Smita S. Subcutaneous cysticercosis presenting as cervical swelling: Amazing and unexpected cytological findings. Indian J Pathol Microbiol [serial online] 2017 [cited 2020 Feb 25];60:288-9. Available from: http://www.ijpmonline.org/text.asp?2017/60/2/288/208395


Cysticercosis, a parasitic tissue infection caused by the larva of Taenia solium, is quite a common disease in our part of the world, but its incidence is often underestimated. Fine needle aspiration cytology (FNAC) plays an important role in early detection of this disease, especially when the lesion is located in anatomically approachable superficial locations.[1],[2] A definite diagnosis of cysticercosis was obtained in the form of parts of parasite tegument, hooklets, parenchymatous portion, and calcareous corpuscles.

The disease most commonly involves subcutaneous and muscle tissues, followed by eye and brain. Cysticercosis can be diagnosed by various radiologic means or by serology, both of which, however, are not definite. Histopathologic examination of excised nodule or swelling containing the cysticerci is the most definite diagnostic method.[3],[4],[5]

A 16-year-old female presented with right-sided cervical swelling of 1½ years duration to the medicine outpatient department. The swelling was 3 cm × 2 cm in size, soft in consistency and was in subcutaneous plane [Figure 1]. Intermittent low-grade fever and altered bowel habits are associated with, which was clinically suspected as tubercular lesion. On ultrasonography, differential diagnosis considered was infected branchial cleft cyst and necrotic lymphadenopathy. FNAC was done using a 23-gauge needle with attached 10 ml disposable syringe, yielded 1.5 ml straw color clear fluid. Air-dried and wet-fixed slides in 95% of ethyl alcohol were prepared and stained with May–Grunwald–Giemsa and Papanicolaou stains, respectively.
Figure 1: Photomicrograph showing presence of head; both armed and unarmed scolex, proglottids, and hooklets (MGG, ×100). Inset shows clinical photograph

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FNAC slides revealed wavy outline fragments of membrane with interspersed uniform small nuclei having salt pepper-like chromatin, presence of head, both armed and unarmed scolex, and proglottids also [Figure 2]. Armed scolex was seen with rostellum, attached hooklets, and four circular suckers [Figure 3]. Unarmed and different parts of proglottids (segments) such as bladder and gravid uterus were also present. Background shows scattered fair number of hooklets, mixed inflammatory cells, few epithelioid-like cells, and occasional giant cells.
Figure 2: Photomicrograph showing fragments of parasitic membrane with wavy outline and embedded salt pepper-like nuclear chromatin (MGG, ×100)

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Figure 3: Photomicrograph showing the presence of head; both armed and unarmed scolex, proglottids (honeycomb appearance), presence of rostellum with hooklets and circular suckers (MGG, ×100)

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The case discussed here was undoubtedly turned out as cysticercus cellulose on cytology, which was not considered by both clinician and radiologist. The patient is on antihelminthic therapy and doing well on follow-up.

FNAC serves as an important initial, minimally invasive diagnostic modality for detecting parasitic infections.

The tissue response to cysticercus has been divided into five stages. The initial response comprises macrophages and lymphocytes, followed by a well-formed layer of palisaded histiocytes. As the inflammatory response becomes chronic, eosinophils appear; later on, polymorphs invade the necrotizing parasite.[3],[4]

Cysticercosis generally presents as a soft-tissue swelling and is not clinically diagnostic, where there was no clinical suspicion of cysticercosis. In cases where clear fluid is aspirated with eosinophil predominance, a careful search for the parasitic fragments and hooklets must be done.[5]

FNAC is a rapid, safe, cost-effective, easy, sensitive, and reliable tool for diagnosing cysticercosis and can prevent fatal neurological complications. In the present case, the patient gave a history of convulsions, and computed tomography scan of the head was suggested which was reported unremarkable. Cysticercosis is more common than usually thought; hence, the possibility should keep in mind in all inflammatory and cystic lesions.[6]

The presence of full spectrum/parts of parasite with inflammatory response compelled us to report this case.

The case discussed here highlights the presence of all the parasitic elements together in a single case, which is a very rare and an amazing finding to get on cytology. To the best of our knowledge, there are very few cases where the entire spectrum of parasitic elements is demonstrated together in a single case. Cysticercosis should be included in the differential diagnosis of cervical swellings, especially in endemic regions. Timely diagnosis and intervention help in preventing fatal complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Handa U, Garg S, Mohan H. Fine needle aspiration in the diagnosis of subcutaneous cysticercosis. Diagn Cytopathol 2008;36:183-7.  Back to cited text no. 1
    
2.
Elhence P, Bansal R, Sharma S, Bharat V. Cysticercosis presenting as cervical lymphadenopathy: A rare presentation in two cases with review of literature. Niger J Clin Pract 2012;15:361-3.  Back to cited text no. 2
  [Full text]  
3.
Kala P, Khare P. Fine-needle aspiration cytology as a diagnostic modality for cysticercosis: A clinicocytological study of 137 cases. J Cytol 2014;31:68-72.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Malik NP, Singh A. Role of fine-needle aspiration cytology in diagnosis of subcutaneous cysticercosis – A report of 66 cases. Int J Pharm Bio Sci 2013;4:861-6.  Back to cited text no. 4
    
5.
Gill M, Dua S, Gill P, Gupta V, Gupta S, Sen R. Cytomorphological spectrum of subcutaneous and intramuscular cysticercosis: A study of 22 cases. J Cytol 2010;27:123-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Yadav YK, Gupta O, Aggarwal R. Cytological diagnosis of parasites presenting as superficial nodular swelling: Report of 35 cases. J Parasit Dis 2012;36:106-11.  Back to cited text no. 6
    

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Correspondence Address:
Punam Prasad Bhadani
Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_497_16

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