Isolated epitrochlear filarial lymphadenopathy: cytomorphological diagnosis of an unusual presentation

Abstract

Filariasis is a major public health problem in tropical countries like India. Despite the large number of people at risk, detection of eggs with or without larva (microfilaria) on fine-needle aspiration cytology is very unusual, especially in an uncommon site or incidentally detected in clinically unsuspected cases of filariasis with the absence of microfilariae in the peripheral blood. A 19-year-old male presented with swelling over medial aspect of left arm (just above the elbow), with no other specific signs and symptoms. Fine needle aspiration cytology revealed an adult gravid female filarial worm in a background of reactive lymphoid cells and lymphohistiocytic clusters. We report a case with elaborate fine needle aspiration cytology findings of filarial worm infestation with unusual presentation of isolated epitrochlear lymph node involvement in a clinically unsuspected case and recommend clinicians and pathologists to consider a high index of suspicion for such infections at uncommon sites especially in endemic territories, as early diagnosis and treatment prevent the more severe manifestations of disease.

Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases

“…In our study, only three cases were reported from lymph nodes (epitrochlear, cervical, and left axillary lymph node). There have been previously reported cases from similar lymph nodal swellings by Basu et al, Sahu et al, and Raveendram et al 8–10 In our study three cases were reported in urine cytology. There are a few studies where microfilariae were noted in a urinary sample with clinical suspicion of malignancy, but computed tomography (CT) and cystoscopic findings were normal 11,12 …”

Fine-needle aspiration of axillary swelling: Cytodiagnosis of an unusual presentation of filariasis

“…The disease most frequently involves lymphatics of the lower limbs, retroperitoneal tissue, spermatic cord, epididymis, and mammary gland. [3] mf has been identified cytologically by FNAC at unusual sites, such as epitrochlear lymph node, axillary lymph node, breast, spleen, ovarian fluid, bone marrow, thyroid, and liver space-occupying lesion. [4] It has also been reported in various other exfoliative samples.…”