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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;5:46-7
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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 Aug 14];5:46-7. Available from: https://www.atmph.org/text.asp?2012/5/1/46/92883
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. ,,,, 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: Smear shows microfilaria of Wuchereria bancrofti along with malignant squamous cells (H & E, 400×).
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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. ,,,, 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.  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.  Incidental microfilaria has been reported in primary squamous cell carcinoma.  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.
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