Fine Needle Aspiration Cytology of Cysticercosis—A Case Report

Cysticercosis, caused by cysticercus cellulosae, the larval form of Taenia solium, is potentially a dangerous systemic disease with variable clinical manifestations. The disease most commonly involves subcutaneous and muscle tissues, followed by the eye and brain. Cysticercosis can be diagnosed by various radiologic means or by serology, both of which, however, are not definitive. Biopsy and histologic examination containing the cysticerci is the most definitive method of diagnosis. We report a case of cysticercosis in a 27-year-old male patient, who presented with a subcutaneous swelling in the back which was diagnosed on fine needle aspiration cytology (FNAC). 1. Introduction Fine needle aspiration cytology (FNAC) is a well-recognized diagnostic procedure for the evaluation of inflammatory nodules caused by parasites. The diagnostic role of FNAC in cysticercosis was first emphasized by Kung et al. in 1989 [1]. Since then spectrum of cytological details of cysticercosis covering the entire range, from viable cysts through necrotic and calcified lesions has been described [2]. We report a case of cysticercosis diagnosed by FNAC emphasizing certain simple interpretive aspects that are of practical value, especially to cytopathologists who do not have much experience in this field. 2. Case Report A 27-year-old male patient presented with a swelling on the right side of the back of two week duration. The mass was 4 × 4.5？cm in size, soft in consistency, and was in the subcutaneous plane. It was not associated with pain. The clinical diagnosis was that of a lipoma. FNAC was done using 22？G needle and 10？mL syringe. Aspiration yielded straw colored clear fluid. The smears were air dried as well as wet fixed in 95% ethyl alcohol and stained with May Grunwald Giemsa, haematoxylin, and eosin and Papinicolaou stains. On cytology, fragments of bluish fibrillary material with interspersed small nuclei were seen (Figure 1). Thick blue spherules within the substance of the fibrillary material gave a honeycomb appearance. Mixed inflammatory cells consisting of neutrophils, eosinophils, lymphocytes, and histiocytes were seen surrounding the fibrillary material. A diagnosis of parasitic material was offered on cytology. This material was excised and sent for histopathological examination. The parasite cysticercus cellulose was seen in the tissue section with extensive mixed inflammatory cell infiltrate in the surrounding tissue (Figure 2). A final diagnosis of subcutaneous cysticercosis was made. The patient also received oral antihelminthic therapy and is doing well.