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COMMENTARY
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 270-271  

Liquid-based cytological diagnosis of achylous unilateral bancroftian pleural effusion: An uncommon presentation of a common problem


Department of Pathology, Sri Devaraj URS Medical College, Kolar, Karnataka, India

Date of Web Publication15-May-2019

Correspondence Address:
Subhashish Das
Department of Pathology, Sri Devaraj URS Medical College, Tamaka, Kolar, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_228_18

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How to cite this article:
Das S. Liquid-based cytological diagnosis of achylous unilateral bancroftian pleural effusion: An uncommon presentation of a common problem. Med J DY Patil Vidyapeeth 2019;12:270-1

How to cite this URL:
Das S. Liquid-based cytological diagnosis of achylous unilateral bancroftian pleural effusion: An uncommon presentation of a common problem. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 Jul 19];12:270-1. Available from: http://www.mjdrdypv.org/text.asp?2019/12/3/270/258207



Filariasis is a common parasitic disease of the tropical region, and most cases of cytologically diagnosed filariasis are clinically unanticipated. Microfilaria, ova, and fragments of adult worm of Wuchereria bancrofti, in exfoliative as well as aspiration cytology, have been reported and are useful in cytological detection of bancroftian filariasis.[1]

Common methods of diagnosis of filariasis in this country are by demonstration of microfilaria in stained or unstained blood films, circulating filarial antigen detection and demonstration of organism in histopathological sections. Fluid cytology or fine-needle aspiration cytology is rarely applied for routine diagnosis.[2]

Diagnosis of filariasis in cytological smears can also be made by the presence of fragments of adult female or male worms and ova of the filarial organism with or without simultaneous presence of microfilaria. The presence of ova and adult worms of filarial organism in cytological smears may or may not be associated with simultaneous presence of microfilaria.[3],[4]

Adult female worms were the more common finding than male worm, in most of the studies and in reported cases; in addition, most of the female worms detected in smears were gravid containing microfilaria or embryonated ova within their body cavities as well as outside.[5],[6],[7]

As the parasites circulate in the lymphatic and vascular systems, appearance of filarial organism in tissue fluids and exfoliated surface material probably occurs due to conditions causing lymphovascular obstruction, resulting in extravasations of blood and release of microfilariae.[8],[9] Such aberrant migration to these dead-end sites is probably determined by local factors, such as lymphatic blockage by scars, or tumors, and damage to the vessel wall by inflammation, trauma, or stasis.[8],[9]

Microfilariae have been detected in association with metastatic malignant cells in pleural fluid,[10] peritoneal fluid,[11] and pericardial fluid.[12] In the present study, one case of microfilaria was detected in association with metastatic adenocarcinoma in the pleural fluid. Serous cavity effusion such as pleural effusion can be primarily caused by filarial infection, and a search for microfilaria in pleural fluid smears especially in cases of recurrent effusions can be very rewarding if tuberculosis and malignancy are remote possibility.[13]

Liquid-based cytology (LBC) has numerous advantages over the conventional cytology. The main advantages include:

  1. uniform collecting procedure.
  2. standardized sample processing techniques.
  3. availability of residual clinical material for further studies and also for applying ancillary techniques wherever possible.


Although LBC has revolutionized cervical cancer screening worldwide, a major drawback of LBC has been its lack of universal accessibility, particularly with regard to the rural and resources constraint set up like us.[2]

One suggested measure to overcome this drawback is to consider the feasibility of having centrifuged LBC (C-LBC), which has shown promising results in exfoliative cytology of oral mucous.[7]

More such studies are required to conform the diagnostic efficacy of C-LBC with regard to fluid cytology.



 
  References Top

1.
Meyers WM, Neafi RC, Connor DH. In: Diseases caused by filarial Nematodes bancroftian and Malayan filariasis pathology of tropical and extraordinary diseases. Binford CH, Connor DH, editors. An Atlas. Vol. 2. Washington D.C: Armed Forces Institute of Pathology; 1976. p. 340-55.  Back to cited text no. 1
    
2.
Gupta S, Sodhani P, Jain S, Kumar N. Microfilariae in asscociation with neoplastic lesions: report of five cases. Cytopathology 2001;12:120-6.  Back to cited text no. 2
    
3.
Arora VK, Singh N, Bhatia A. Cytomorphologic profile of lymphatic filariasis. Acta Cytol 1996;40:948-52.  Back to cited text no. 3
    
4.
Jain S, Sodhani P, Gupta S, Sakhuja P, Kumar N. Cytomorphology of filariasis revisited. Expansion of the morphologic spectrum and coexistence with other lesions. Acta Cytol 2001;45:186-91.  Back to cited text no. 4
    
5.
Kapila K, Verma K. Diagnosis of parasites in fine needle breast aspirates. Acta Cytol 1996;40:653-6.  Back to cited text no. 5
    
6.
Sah SP, Agarwal CS, Mishra A, Rani S. Chance finding of an adult filarial worm in lymph node. J Nepal Med Assoc 1999;38:45-7.  Back to cited text no. 6
    
7.
Sah SP, Rani S, Mahto R. Microfilariae in lymph node aspirates. Acta Cytol 2002;46:73-5.  Back to cited text no. 7
    
8.
Vassenwala SM, Khan AA. Microfilaria in urinary sediment smears in association with carcinoma of urinary bladder. Report of two cases with review of literature. J Cytol 1990;7:19-23.  Back to cited text no. 8
    
9.
Walter A, Krishnaswami H, Cariappa A. Microfilariae of Wuchereria bancrofti in cytologic smears. Acta Cytol 1983;27:432-6.  Back to cited text no. 9
    
10.
Sivakumaran P, Wilsher ML. Microfilarial pleural effusion associated with adenocarcinoma. Aust N Z J Med 1997;27:341.  Back to cited text no. 10
    
11.
Khan AA, Vasenwala SM, Ahmad S. Coexistent metastatic adenocarcinoma and microfilaria in ascitic fluid. Acta Cytol 1993;37:643-4.  Back to cited text no. 11
    
12.
Varghese R, Raghuveer CV, Pai MR, Bansal R. Microfilariae in cytologic smears: A report of six cases. Acta Cytol 1996;40:299-301.  Back to cited text no. 12
    
13.
Marathe A, Handa V, Mehta GR, Mehta A, Shah PR. Early diagnosis of filarial pleural effusion. Indian J Med Microbiol 2003;21:207-8.  Back to cited text no. 13
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