Journal of Cytology
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Year : 2020  |  Volume : 37  |  Issue : 1  |  Page : 65-66
Incidental finding of microfilaria in cervicovaginal liquid-based cytology smear


Department of Pathology, PGIMER and Dr. RML Hospital, New Delhi, India

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Date of Submission06-Jun-2019
Date of Acceptance13-Oct-2019
Date of Web Publication23-Dec-2019
 

How to cite this article:
Jain S, Gupta P, Bhardwaj M. Incidental finding of microfilaria in cervicovaginal liquid-based cytology smear. J Cytol 2020;37:65-6

How to cite this URL:
Jain S, Gupta P, Bhardwaj M. Incidental finding of microfilaria in cervicovaginal liquid-based cytology smear. J Cytol [serial online] 2020 [cited 2020 Jan 28];37:65-6. Available from: http://www.jcytol.org/text.asp?2020/37/1/65/273803




Sir,

An 80-year-old woman presented with complaints of postmenopausal bleeding for 8 days and a painless abdominal lump since 4 years which was gradually increasing in size. There was no history of dysmenorrhea, fever, trauma, hematuria, bleeding per rectum, or genital tract surgery. The patient was diabetic and hypertensive but not on any medication. On per-speculum examination, a cervical polyp measuring 2 × 1 cm was seen arising from the lower lip of cervix with bloody discharge. Routine hematological and biochemical parameters were within normal limits except for the raised fasting blood sugar (145 g/dl). Ultrasonographic (USG) examination of whole abdomen and pelvis revealed a heterogeneous, hypoechoic lesion measuring 1.4 × 1.2 × 1.2 cm replacing fundus and body. A 2 ml hemorrhagic endometrial aspirate was sent for cytological examination. Smears showed predominantly hemorrhage admixed with occasional groups of endocervical cells and sheathed microfilaria larva with smooth curves and nuclei not extending to tip of the tail [Figure 1]a. However, endometrial cells were not seen. Further, cervicovaginal conventional  Pap smear More Detailss and liquid-based cytology (LBC) preparations (Sure Path, Tri Path, USA) revealed the presence of similar larvae with mature squamous cells, endocervical cells and mild prominence of eosinophils [Figure 1]b and c] with absent malignant cells. The patient underwent cervical polypectomy which on histopathology sections showed features of endocervical mucosal polyp. Sections from endocervical curettings revealed fragment of sheathed microfilaria [Figure 1]d. Peripheral blood smear (PBS) examination did not show eosinophilia or microfilaria either. The case was of occult filariasis; suggestive of Wuchereria bancrofti infestation.
Figure 1: (a) Endometrial aspirate smear shows microfilaria larva and occasional group of endocervical cells (arrow) (Giemsa, ×200). (b) Conventional Pap smear shows microfilaria larva in a background of squamous cells and inflammatory cells (arrow) (Papanicolaou, ×400). (c) Liquid-based cytology smear: Microfilaria larva, mature squamous cells, and group of endocervical cells (Papanicolaou,×400). (d) Endocervical curettings: Section show sheathed microfilaria larva (Hematoxylin and Eosin, ×400)

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The patient was advised computed tomography (CT) abdomen and pelvis to rule out malignancy. The patient was treated with diethylcarbamazine (DEC) 6 mg/kg bodyweight for 21 days and tranexamic acid to control vaginal bleeding. The patient denied further investigations and was lost to follow-up.

Filariasis, a vector-borne serious health disease is common in tropical countries, including India. It is caused mainly by two closely related nematodes Wuchereria bancrofti and Brugia malayi. Incidental detection of microfilaria has been documented in various cytological samples. However, only meager cases of microfilaria in cervicovaginal Pap smears are reported. This case reports the same and highlights the incidental finding of microfilaria in LBC smears. The conventional diagnosis of filariasis relies on finding microfilaria in a PBS. The relative difference of oxidative stress during inflammation is attributed to different clinical presentation and absence of PBS eosinophilia seen in occult filariasis.[1] Filariasis of female genital tract is rare with reported cases showing involvement of uterus, ovary, mesosalpinx,  Fallopian tube More Details, cervix, and vulva.[2] It is all the more rare to find microfilaria coexistent with gynecological malignancies.

The sample sent as endometrial aspirate in our case did not reveal endometrial cells and rather had cells from lower genital tract; probably resulting from nonrepresentative sample collection. To the best of our knowledge, on reviewing the English literature, a total of 29 cases of occult filariasis in cervicovaginal Pap smears were found.[2],[3],[4],[5] However, no single case has reported microfilaria on LBC smears.

To conclude, microfilaria with eosinophils may present as an incidental finding in the tissue with absence of these in PBS. We reiterate the uncommon finding of microfilaria in cervicovaginal Pap smears and highlight its presence in the LBC smears.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Pal BK, Kulkarni S, Bhandari Y, Ganesh BB, Goswami K, Reddy MVR. Lymphatic filriasis: Possible pathophysiological nexus with oxidative stress. Trans R Soc Trop Med Hyg 2006;100:650-5.  Back to cited text no. 1
    
2.
Dhanya CSR, Jayaprakash HT. Microfilariae, a common parasite in an unusual site: A case report with literature review. J Clin Diagn Res 2016;10:8-9.  Back to cited text no. 2
    
3.
Sood N, Malhotra J. Sticky microfilaria in cervical pap smears: An unusual observation. OA Case Reports 2014;3:67.  Back to cited text no. 3
    
4.
Parida BB, Srangi A, Das S. Presence of microfilaria of Wuchereria bancrofti in cervicovaginal smears. Acta Cytol 1990;34:287-9.  Back to cited text no. 4
    
5.
Sangeetha RS, Dhanya R, Jayaprakash HT. Cytomorphology of vaginal pap smears: A spectrum of lesions in a tertiary hospital. Indian J Pathol Oncol 2016;3:320-7.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Prajwala Gupta
Department of Pathology, Room No. 305, OPD Block 3rd Floor, PGIMER and Dr. RML Hospital, Baba Kharak Singh Marg, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_81_19

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