Cytomorphological spectrum of subcutaneous and intramuscular cysticercosis: A study of 22 cases

Abstract

Background: Cysticercosis is more common than usually thought. Fine needle aspiration cytology (FNAC) plays an important role in prompt recognition of this disease.

Aims: To study the role of FNAC in the diagnosis of cysticercosis.

Materials and methods: Twenty-two patients with subcutaneous and intramuscular nodules, who were clinically diagnosed as tuberculous lymphadenitis, reactive lymphadenitis, lipoma, neurofibroma and cysticercosis were included in the present study.

Results: In nine cases, a definitive diagnosis of cysticercosis was obtained in the form of fragments of parasite bladder wall and, biopsy confirmed the diagnosis. In the rest 13 cases, larval fragments could not be identified on the aspirates and the diagnosis of parasitic inflammation was suggested on the basis of other cytomorphological findings. Follow-up biopsy confirmed the diagnosis of cysticercosis.

Conclusions: FNAC in cysticercosis is a low-cost outpatient procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structure is identified in the smears. However, in other cases, presence of eosinophils, histiocytes which may be in palisaded clusters or not, a typical granular dirty background, etc., are the features which should always alert the pathologist to this possibility.

Keywords: Cysticercosis; fine needle aspiration cytology; parasite.

Figure 1

Photomicrograph showing wall of cysticercosis cellulosae (a and b) (Giemsa, ×100), (c–f) higher magnification (Giemsa, ×400)

Figure 2

Wall of cysticercus with surrounding acute inflammatory cells (Giemsa, ×400)

Figure 3

Photomicrograph showing epithelioid cell granulomas (Giemsa, ×400)

Figure 4

Photomicrograph of tissue section showing cysticercus larva enclosed in a thin fibrous cyst wall (H and E, ×100)