International Journal of Scientific and Research Publications, Volume 4, Issue 8, August 2014
ISSN 2250-3153
Cervical lymphadenopathy in a Child An unusual
presentation of filariasis
Dr Arpita Jindal*, Dr Deepti Sukheeja**, Dr Manojit Midya***
*
Associate Professor, Department of Pathology, SMS Medical College , Jaipur, Rajasthan (India)
Senior Resident, Department of Pathology, Government Medical College and associated group of hospitals, Kota, Rajasthan (India)
***
Senior Resident, Department of General Surgery , Government Medical College and associated group of hospitals, Kota, Rajasthan (India)
**
Abstract- Clinical manifestations of lymphatic filariasis
depend on the area of lymphatic involvement and the duration of
infection. An eight year old child presented with right cervical
lymph node. Fine needle aspiration cytology (FNAC) with 22
Gauge needle from the lymph node revealed multiple coiled
larvae of Wuchereria bancrofti in a background of reactive
lymphoid cells with eosinophils. Diagnosis of right cervical
Bancroftian lymphadenopathy was made. The case was followed
by excisional biopsy of the lymph node and hence was confirmed
histopathologically. We report this case because cervical
lymphadenopathy is a rare presentation of filariasis in children.
Index Terms- Cervical lymphadenopathy, child, filariasis, fine
needle aspiration cytology.
I. INTRODUCTION
Filariasis is a tropical disease transmitted by the Culex
mosquitoes. The diagnosis of it is conventionally made by
demonstrating microfilariae in the peripheral blood smear.
However microfilariae and adult filarial worm have been
incidentally detected in fine needle aspirates of various lesions in
clinically unsuspected cases. Lymphatic filariasis is a major
health problem in India especially in its southern states. A
majority of the infected individuals in endemic areas are
asymptomatic. Adult worms in the lymphatics cause progressive
lymphatic vascular dilatation and dysfunction. Patients usually
presents as lower limb lymphedema, hydrocele, chyluria
or inguinal lymphadenopathy.[1] Cervical lymphadenopathy is
an extremely uncommon presentation of filariasis even in
endemic communities. We thus present a case of filarial
lymphadenopathy of the cervical region which was further
followed by exicisional biopsy.
II. CASE REPORT
An 8 year old male child presented to Surgical OPD for a
painless enlarged lymph node in right side posterior cervical
region since 6 months. He had no history of fever, cough, weight
loss, swelling of the left upper extremity or any lumps elsewhere
in the body . On clinical examination there was a 2 x 2 cm in
size firm, painless, mobile and non-tender swelling. No other
lymph node groups were enlarged. External genitalia was
normal. General examination revealed no other abnormalities. A
clinical diagnosis of reactive lymphadenitis was made.
His chest x-ray was unremarkable. His total leucocyte count was
normal with 6% eosinophils. Routine and microscopic
examination of the urine was within normal limits. A scrotal
ultrasound scan was not done as the external genitalia were
normal.
FNAC from the lymph node was performed and smears were wet
fixed in 95% ethanol and stained with haematoxylin eosin (HE) stain. Microscopic examination revealed multiple coiled
larvae of Wuchereria bancrofti ( fig 1) in a background of
reactive lymphoid
cells with eosinophils. The case was
confirmed histologically after its excisional biopsy. Histology
showed few histiocytic granulomas with presence of eosinophils
with larvae of W. bancrofti present in the centre of the
granulomas ( fig 2).
III.
DISCUSSION
Lymphatic filariasis is a major health problem in India with most
infections caused by Wuchereria bancrofti. The presence of adult
worms in the infected individuals is confirmed by detecting
microfilariae or filarial antigens in the patient's blood.[2] The
diagnosis of a filarial infection can also been made by detecting
microfilariae on microscopic examination of fine needle aspirates
from lymph nodes.[3,4] FNAC from breast mass, thyroid mass,
hydrocoele fluid, pericardial fluid, pleural fluid, ascitic fluid, and
cytology of cervicovaginal smears, bronchial aspirates, urine,
nipple secretion, bone marrow and joint fluid aspirates have also
been reported to yield microfilariae.[5,6] In these patients the
peripheral smears rarely revealed microfilaremia or
eosinophilia.[5,6]
Kapila and Verma documented gravid adult female worms of
Wuchereria bancrofti in two inguinal lymph nodes aspirates. [7]
Arora et al demonstrated the adult worm of Brugia malayi in an
epitrochlear lymphnode aspirate.[8] Trupti et al reported
microfilaria in cervical lymphadenopathy in a patient with
metastasis of squamous cell carcinoma of esophagus[9] .Filariasis
can be detected in a clinically unsuspected case, especially in an
endemic zone. The spectrum of host response may vary from no
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International Journal of Scientific and Research Publications, Volume 4, Issue 8, August 2014
ISSN 2250-3153
reaction to a marked inflammatory or granulomatous response.
The entire spectrum of changes should be kept in mind while
practicing cytopathology in filaria prone endemic area. In such
situations, a high index of suspicion and careful screening of
cytology smears are keys to a correct diagnosis.
In conclusion, although scrotal lymphatics and inguinal lymph
nodes are the preferred location for adult W. bancrofti, cervical
lymph nodes may also be affected. These cases can be
misdiagnosed as reactive hyperplasia and can be left untreated
which can lead to progression of disease.
AUTHORS
First Author Dr. Arpita Jindal, Associate Professor,
Department of Pathology, SMS Medical College, Jaipur-324005,
Rajasthan (India).
Second Author Dr. Deepti Sukheeja, Senior Resident,
Department of Pathology, Government Medical College and
associated group of hospitals, Kota-324005, Rajasthan (India).
Third Author Dr. Manojit Midya, Senior Resident,
Department of General Surgery, Government Medical College
and associated group of hospitals, Kota-324005, Rajasthan
(India). E-mail: manojitmidya@[Link]
REFERENCES
1.
Sen SB, Chatterjee H, Ramaprasad S et al. Chylous manifestations of
filariasis: A clinical and lymphographic study. Part II.
Lymphadenovarix, chylocele and chylous scrotum. Ind Jour Med Res
1969; 57: 173844.
2.
Dreyer G, Santos A, Noroes J, Addiss D et al. Proposed panel of
diagnostic criteria, including the use of ultrasound, to refine the
concept of 'endemic normals' in lymphatic filariasis. Tropical
Medicine and International Health 1999; 4: 5759.
3.
Dey P, Radhika S, Jain A et al. Microfilariae of Wuchereria bancrofti
in a lymph node aspirate. A case report Acta Cytol. 1993; 37: 7456.
4.
Kapila K, Verma K et al. Diagnosis of parasites in fine needle breast
aspirates. Acta Cytol 1996; 40: 6536.
5.
Varghese TR, Raghuveer CV, Pai MR, Bansal R et al. Microfilariae in
Cytologic Smears. A Report of Six Cases. Acta Cytol 1996; 40: 299
01.
6.
Walter A, Hemalatha K, Cariappa A et al. Microfilariae of Wuchereria
bancrofti in cytologic smears. Acta Cytol 1983; 4: 4326.
7.
Kapila K, Verma K et al: gravid adult female worms of Wuchereria
bancrofti in fine needle aspirates of soft tissue swellings: Report of
three cases. Acta Cytol. 1989; 33: 390-2.
8.
Arora VK, Sen B, Dev G,Bhatia A et al: Fine needle aspiration
identification of adult worm of Brugia malayi and its ovarian fragment
from an epitrochlear lymph node. Acta Cytol 1993; 37: 437-8.
Correspondence Author Dr. Manojit Midya, Senior
Resident, Department of General Surgery, Government Medical
College and associated group of hospitals, Kota-324005,
Rajasthan (India). E-mail: manojitmidya@[Link]
FIGURE 1: Cytosmears of lymph node showing coiled larva of
[Link] in the midst of reactive lymphoid infiltrate and
eosinophils (H& E Stain, 400x)
No. of figures- Two
Source(s) of support- Nil
Conflict of interest- None
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International Journal of Scientific and Research Publications, Volume 4, Issue 8, August 2014
ISSN 2250-3153
FIGURE 2: Tissue section showing larva surrounded by granulomatous reaction (H& E Stain, 100x)
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