Annals of Tropical Medicine and Public Health

LETTER TO THE EDITOR
Year
: 2012  |  Volume : 5  |  Issue : 1  |  Page : 46--47

Microfilaria in aspirate from metastatic squamous cell carcinoma in cervical lymph node


Monisha Choudhury, Mukta Pujani, Narender Tejwani, Meenakshi Rao 
 Department of Pathology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India

Correspondence Address:
Mukta Pujani
Department of Pathology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi 110 001
India




How to cite this article:
Choudhury M, Pujani M, Tejwani N, Rao M. Microfilaria in aspirate from metastatic squamous cell carcinoma in cervical lymph node.Ann Trop Med Public Health 2012;5:46-47


How to cite this URL:
Choudhury M, Pujani M, Tejwani N, Rao M. Microfilaria in aspirate from metastatic squamous cell carcinoma in cervical lymph node. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Apr 8 ];5:46-47
Available from: http://www.atmph.org/text.asp?2012/5/1/46/92883


Full Text

Sir,

Incidental finding of microfilaria in cytological smears is common and has been described in Ewings sarcoma of bone, thyroid nodules, carcinoma pancreas, malignant effusions in ascitic fluid, breast lump, bone marrow aspirate, and primary tumor of maxillary antrum. [1],[2],[3],[4],[5] We report an interesting case of incidental detection of microfilaria in metastatic squamous cell carcinoma in a cervical lymph node.

A 52-year-old man presented with chief complaints of painless swelling in the neck, gradually increasing in size along with hoarseness of voice since past one month. The patient had a history of smoking and tobacco chewing for the past 20 years. Indirect laryngoscopic examination revealed a supra glottic growth, bleeding on touch. There was a hard mass in the right jugulodigastric region measuring 2 × 2 cm2. The hematological findings revealed hemoglobin-10.5 g%, a total leucocyte count of 9600/μl, and smears were negative for microfilaria on three occasions. A clinical diagnosis of carcinoma larynx with suspected metastasis to cervical lymph node was considered. Fine needle aspiration cytology of cervical lymph node was performed. Smears were cellular with the presence of malignant squamous cells in a background of necrotic debris, foamy macrophages, and lymphoid cells. On screening, occasional sheathed microfilaria without nuclei at the tail end was observed. A diagnosis of metastatic squamous cell carcinoma in a lymph node with coexistent Wuchereria bancrofti was made [Figure 1].{Figure 1}

Lymphatic filariasis is an endemic infectious disease in tropical countries, north east Asia and India. The disease primarily involves the various lymphatic structures of body including lymphatics of lower limbs, scrotum, epididymus, and mammary glands. Detection of microfilaria in cytological smears is a common incidental finding. Review of literature has shown the presence of the organism in cervicovaginal smears, endometrial smears, nipple secretions, breast aspirates, pleural fluid, bronchial washings, lymph node aspirates, salivary glands carcinoma maxillary antrum, carcinoma pancreas, soft tissue aspirates, brain aspirates, joint aspirates, Ewings sarcoma, thyroid nodules, and bone marrow aspirates. [1],[2],[3],[4],[5] In our case, the parasite was detected incidentally in metastatic squamous cell carcinoma in a cervical lymph node. The presence of organism in body and cyst fluid aspirates may be due to extravasation from capillaries following lymphatic and vascular obstruction. [2] Although the finding of microfilariae in cytologic smears is considered incidental, the association of microfilariae with debilitating conditions suggests that it is an opportunistic infection. [3] Incidental microfilaria has been reported in primary squamous cell carcinoma. [5] To the best of our knowledge, this is the first case report describing incidental microfilaria in a metastatic squamous cell carcinoma in a cervical lymph node.

References

1Agarwal PK, Srivastava AN, Agarwal N. Microfilaria in association with neoplasms. Acta Cytol 1982;26:488-90.
2Walter A, Krishnaswami H, Cariappa A. Microfilaria of Wuchereria bancrofti in cytologic smears. Acta Cytol 1983;27:432-6.
3Gupta K, Sehgal A, Puri MM, Sidhwa HK. Microfilaria in association with other diseases: A report of six cases. Acta Cytol 2002;46:776-8.
4Jain S, Sodhani P, Gupta S, Sakhuja P, Kumar N. Cytomorphology of filariasis revisited. Expansion of the morphologic spectrum and coexistence with other lesions. Acta Cytol 2001;45:186-91.
5Mohan G, Chaturvedi S, Mishra PK. Microfilaria in a fine needle aspirate of primary solid malignant tumor of the maxillary antrum: A case report. Acta Cytol 1998;42:772-4.