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 Table of Contents  
LETTERS TO THE EDITOR
Year : 2018  |  Volume : 6  |  Issue : 1  |  Page : 192-193

Unusual finding in scalp swelling: Microfilaria in fine-needle aspiration and trichilemmal cyst in histopathology


1 Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Surgical Oncology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

Date of Web Publication11-Jun-2018

Correspondence Address:
Dr. Rashmi Patnayak
Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_31_18

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How to cite this article:
Patnayak R, Ray M, Jena A. Unusual finding in scalp swelling: Microfilaria in fine-needle aspiration and trichilemmal cyst in histopathology. Arch Med Health Sci 2018;6:192-3

How to cite this URL:
Patnayak R, Ray M, Jena A. Unusual finding in scalp swelling: Microfilaria in fine-needle aspiration and trichilemmal cyst in histopathology. Arch Med Health Sci [serial online] 2018 [cited 2018 Dec 14];6:192-3. Available from: http://www.amhsjournal.org/text.asp?2018/6/1/192/234101



Sir,

Fine-needle aspiration cytology (FNAC) is considered as a safe diagnostic method in cutaneous nodules.[1] However, FNAC has limitation regarding the proper representation of samples.[1] In tropical countries particularly in India, filariasis remains a major health problem [2],[3]

Hereby, we describe an interesting case of a 50-year-old female who presented with nontender scalp swelling of 7 cm × 6 cm [Figure 1]a. She gave a long history spanning over years of noticing the swelling; however, she had not taken any medical consultation and the swelling kept gradually increasing in size. FNAC was done, and the smears revealed many microfilariae [Figure 1]b and [Figure 1]c. Her routine hematological examination was within normal limit, and the peripheral smear did not reveal any microfilaria. She underwent excisional biopsy and the histopathological examination showed features of trichilemmal cyst with multiple foci of calcification [Figure 1]d and [Figure 1]e. Careful search did not show any tissue microfilaria.
Figure 1: (a) Clinical picture of scalp swelling (white arrow). (b) Fine-needle aspiration cytology of scalp swelling showing microfilaria (Giemsa, ×100) (black arrow). (c) Nuclear details of microfilaria in cytosmears (Giemsa ×400) (black arrow). (d) Histopathology of trichilemmal cyst (H and E, ×40) (black arrow). (e) Histopathology of trichilemmal cyst showing trichilemmal keratinization and calcification (H and E, ×40) (black arrow)

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Filariasis is an endemic disease in tropical and subtropical region worldwide.[3],[4],[5] In India, filariasis is still a major public health problem. The conventional diagnostic procedure is a demonstration of microfilaria in peripheral blood smears. Even though incidence is high, it is unusual to detect microfilaria in FNAC smears. Incidental demonstration of microfilariae in fine-needle aspirates of different types of lesions has been reported earlier. Most of the cases were not suspected clinically, and microfilariae were not detected in the peripheral blood.[3],[4],[5] Clinical presentations of filariasis vary a lot, and in the majority of cases, the disease is detected as an incidental finding.

We report this case because of the peculiar association where the microfilaria was incidentally detected in FNAC smears, and the histopathology showed trichilemmal cyst. The patient had an uneventful hospital stay.

In endemic areas, filariasis should be included in the differential diagnosis of superficial swellings.

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patel S, Mahadevappa A, Manjunath GV. Fine needle aspiration cytology of papulonodular lesions of skin: A study of 50 cases. J Clin Diagn Res 2016;10:EC09-13.  Back to cited text no. 1
    
2.
Mitra SK, Mishra RK, Verma P. Cytological diagnosis of microfilariae in filariasis endemic areas of Eastern Uttar Pradesh. J Cytol 2009;26:11-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Belokar WK, De Sa O, Amonkar DP, Dharwadkar AM, Priolkar RP. Uncommon manifestations of filariasis. J Postgrad Med 1983;29:170-4B.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Al Bozom I, Koshy SM, Mahdi H, Abdullah MF, Bedair EM. Retroperitoneal filariasis diagnosed by fine needle aspiration: A case report. Acta Cytol 2010;54:325-7.  Back to cited text no. 4
[PUBMED]    
5.
Haleem A, Al Juboury M, Al Husseini H. Filariasis: A report of three cases. Ann Saudi Med 2002;22:77-9.  Back to cited text no. 5
[PUBMED]    


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