Uma Sharma

Lymphatic filariasis: aspiration of adult gravid female worm from a soft tissue swelling.

Sir, A 35 year-old male resident of Bihar, presented with a soft tissue swelling along the medial aspect of right arm, measuring 2 cm in diameter, of 4 months duration, associated with local pain. He had low grade fever since 2 months and his routine hemogram was normal. His erythrocyte sedimentation rate (ESR) was 64 mm at the end of 1 hour. Clinical diagnosis of tuberculosis was made. Fine needle aspiration cytology (FNAC) from the nodule yielded fluid along with a creamy white thread. Smears showed adult gravid female filarial worm having an intact outer cuticle layer and body cavity containing paired uteri filled with different stages of developing microfilariae. Also, few microfilariae were seen protruding out from the breach in the cuticle layer [Figure 1]. In addition, numerous embryos and coiled larvae [Figure 2] and fully straightened larvae of Wuchereria bancrofti which were sheathed and had no nuclei in the tail end were seen. The background was composed of inflammatory cells including neutrophils, lymphocytes, macrophages and eosinophils. Figure 1 Adult gravid female worm with numerous microfilariae (Giemsa, ×40) Figure 2 (a) Embryonated eggs and coiled microfilariae (Giemsa, ×100), (b) coiled microfilariae (Giemsa, ×100) The patient was then treated with oral diethylcarbamazine and his swelling disappeared. He was followed for 4 months and is doing well. Filariasis is a major health problem in tropical countries including the Indian subcontinent. It is caused by any of three closely related parasitic nematodes - Wuchereria bancrofti, Brugia malayi or Brugia timori. Wuchereria bancrofti, a human nematode parasite, is capable of producing disease due to migration of adult parasite through the lymphatic system.[1] The adult Wuchereria bancrofti may produce lesions by involving the lymphatics of the lower limbs, spermatic cord, epididymis, testis, retroperitoneum and female breast.[1] Its typical presentation are elephantiasis, chronic lymphoedema, epididymitis, funiculitis and lymphadenitis.[1,2] In spite of a large number of such lesions diagnosed on cytology, it is unusual to find adult filarial worms. Most people with microfilaraemia do not show signs or symptoms of the disease but are important source of infection in the community. Symptomatic lymphatic filariasis has very low microfilaraemia. Thus, disease and infection do not necessarily accompany each other.[3] In the present case, the patient had a solitary swelling from which fluid and fragment of adult worm was aspirated. There are a few reports of adult filarial worms in aspirates of soft tissue swellings,[1,3] lymph node[4,5] and epididymal nodules. In all these cases, the swelling was painless and the patient was asymptomatic. In none of the cases, a clinical diagnosis of filariasis was considered. Most of the soft tissue swellings associated with fever are diagnosed as tuberculous or pyogenic. FNAC can distinguish between these swellings accurately and plays an important role in their correct diagnosis. Thus, in countries where lymphatic filariasis is endemic, it should be considered in the clinical differential diagnosis of a soft tissue swelling. FNAC is a convenient and effective diagnostic method in patients with soft tissue mass. Thus, to conclude, identification of parasite in cytology smears plays an important role in diagnosis of disease and institution of specific treatment.

Cytomorphology of pleomorphic fibroma of skin: A diagnostic enigma

Pleomorphic fibroma (PF) is a benign, polypoid, or dome-shaped cutaneous neoplasm with cytologically atypical fibrohistiocytic cells. We describe the cytomorphological features of PF retrospectively with histopathological diagnosis in a 38-year-old male who presented with 3 × 1.5 cm swelling in the soft tissues of the thigh for 6 months. This lesion is benign despite the presence of pleomorphic or bizarre cells. We review the differential diagnosis of PF with other mesenchymal tumors. To the best of our knowledge, cytomorphological features on fine needle aspiration cytology of this tumor are not yet documented in literature.

Squamous predominant Teratoid Wilms' tumor

Teratoid Wilms tumor is an unusual histological variant of nephroblastoma with predominant heterologous component. Frequently present components include adipose tissue, glial tissue, muscle, cartilage or bone. The presence of squamous epithelial component on the other hand is rarely reported. We describe a case of unilateral teratoid Wilms’ tumor in a 2-year-old boy with lung metastasis. In this case, tumor showed the familiar triphasic histologic pattern of nephroblastoma along with extensive squamous epithelial component.

Congenital granular cell lesion in newborn mandible

Congenital granular cell lesion (CGCL) is a rare non-neoplastic lesion found in newborns also known as Neumanns tumor. This benign lesion occurs predominantly in females mostly as a single mass. The histogenesis and natural history of the lesion remains obscure. It arises from the mucosa of the gingiva, either from the maxillary or mandibular alveolar ridge. The lesion is more common in the maxillary alveolar ridge than the mandibular.The present report describes a case of congenital granular cell lesion in an eight-day-old female child who was born with a mass on the anterior mandibular alveolar ridge. The mass was protruding from her mouth and compromised feeding. A clinical diagnosis of teratoma was suggested. Histologically, cells of this lesion are identical to granular cell tumor (neuroectodermal type) and show intense diastase-resistant Periodic Acid Schiff positivity. Immunohistochemically, cells are positive for vimentin but negative for S-100 and desmin, thus suggesting that CGCL is possibly derived from primitive gingival mesenchymal cells rather than having schwannian origin.

Villoglandular papillary adenocarcinoma of cervix: A prognostic dilemma

Adenocarcinomas are the second most common type of cervical cancers in women comprising 10-20% of the cases. Villoglandular papillary carcinoma is a rare histological subtype of invasive adenocarcinoma which usually afflicts young women and carries an excellent prognosis. However, additional histological subtypes mixed with villoglandular papillary adenocarcinoma are very common; therefore, a careful inspection of the specimen should be undertaken and only if it is an exclusive or almost exclusive pattern, should a diagnosis of villoglandular papillary adenocarcinoma be made. This is because the mixed patterns do not present with the same favorable prognosis as the villoglandular adenocarcinoma; moreover, the treatment modalities would also differ. One should consider whether conservative therapy is sufficient because of the predominance of concomitance of other carcinomas besides the villoglandular papillary adenocarcinoma. We present the case of a 47-year-old lady who, on initial biopsy from cervical growth, revealed a villoglandular adenocarcinoma, but subsequent hysterectomy revealed moderately differentiated adenocarcinoma with extrauterine extension.